A New IVH Scoring System Based on Laterality Enhances Prediction of Neurodevelopmental Outcomes at 3 Years Age in Premature Infants

Abstract

To compare the new intraventricular hemorrhage (IVH) Abdi score to the Papile grading system of IVH for prediction of composite outcome of death or neurodevelopmental impairment (NDI). In a cohort study, all preterm infants with IVH who were born ≤1,250 g and/or ≤ 28 weeks of gestation at birth were prospectively followed up in our neonatal follow-up clinic. All cranial ultrasounds of the included infants were reviewed by neuroradiologists who were blinded to the clinical data and neurodevelopmental outcomes. Cranial ultrasounds were graded according to the Papile scoring system and by calculation of the Abdi score. A total of 183 preterm infants met inclusion and exclusion criteria. Of these, 80 (44%) had the composite primary outcome of death or NDI (51 died, 29 survived with NDI). The area under receiver operating characteristic curve for predicting death or NDI was 0.87 (95% confidence interval [CI]: 0.81-0.93) for Abdi score and 0.85 (95% CI: 0.79-0.91) for Papile grading (= 0.04). Abdi scores had higher specificity than Papile grade II at Abdi score 5 (63.9 vs. 39.2%; < 0.001) and Abdi score 6 (73.2 vs. 39.2%; < 0.001). Abdi scores seem to be more specific than Papile grading system in predicting death or NDI by 3 years' corrected age.

Does duration of caffeine therapy in preterm infants born ≤1250 g at birth influence neurodevelopmental (ND) outcomes at 3 years of age?

“…Logistic regression was used to adjust for clinically important neonatal variables of GA, BPD, IVH, NEC, sepsis, ventilator days, Score for Neonatal Acute Physiology-II (SNAP II) scores, postnatal dexamethasone, blood transfusions, and maternal smoking on the ND outcomes of infants in each group. IVH, grade III and greater, was shown to be significantly associated with mild to severe ND impairment of our infants (Tables 4a and 4b), which is consistent with previous studies [40][41][42][43]. BPD is a multifactorial disease and related with duration of mechanical ventilation and postnatal use of steroids.…”

Consensus Approach for Standardizing the Screening and Classification of Preterm Brain Injury Diagnosed With Cranial Ultrasound: A Canadian Perspective

“…This more simplified approach may be flawed since bilateral GMH-IVH is equal or more prevalent than unilateral GMH-IVH, and the likelihood of a poor outcome increases with bilateral injury. Improved prognostication of neurodevelopmental outcome post GMH-IVH has been reported in preterm infants based upon laterality of brain injury (21). The independent grading of GMH-IVH for the right and left cerebral hemisphere is thus considered to be more informative and is recommended for use in our consensus viewpoint.…”

“…Our group is planning to develop a national neonatal cUS training program to standardize cUS image acquisition, interpretation, and reporting for the very preterm population across Canadian tertiary centers. Once center variability in relation to cUS protocols and definitions of preterm brain injury has been reduced, we will begin comparative effectiveness research and work on revising and expanding the classification further to address important issues such as the extend and location of the PVHI and intraparenchymal hemorrhage (21,55). These studies will enable comparison of evidence-based interventions targeting the prevention of preterm brain injury and will identify those centers with low rates of brain injury (adjusted for their population characteristics).…”

Intracranial Hemorrhage and 2-Year Neurodevelopmental Outcomes in Infants Born Extremely Preterm

“…The Papile system also does not take into account the laterality of the bleeds or any other associated cerebral abnormalities such as white matter damage seen as echogenic or echolucent lesions, which are the strongest predictors of death, NDI, and CP. 60,61 However, we feel that the limitations of the system were largely mitigated by the fact that all ultrasounds were read centrally, and that statistical analyses considered each grade of ICH as a separate factor rather than looking for trends across grades. Finally, although the posterior fossa was imaged using the mastoid fontanel, the gold standard for diagnosing cerebellar hemorrhage is by MRI.…”