Neurodevelopmental outcome of preterm infants with ventricular dilatation with and without associated haemorrhage

Abstract

This study investigated whether in preterm children who had ventricular dilatation (VD) on neonatal cranial ultrasound outcome at age 8 years was influenced by the additional presence of germinal matrix haemorrhage -intraventricular haemorrhage (GMH-IVH). Six-hundred and ninety-nine preterm infants (<33wks' gestation, mean 29.6wks [SD 2.1]) with either normal cranial ultrasound (n=616; 286 females, 330 males), or with VD with (n=66; 32 females, 34 males) or without (n=17; 4 females, 13 males) GMH-IVH were enrolled in the study. At age 8 years outcome was assessed in 567 (81%) of the 699 children by neurological examination, the Test of Motor Impairment (TOMI), the test of Visuo-Motor Integration (VMI), and the Wechsler Intelligence Scales for Children. Results showed that the proportion of children with disabling impairments was higher in the group with VD and GMH-IVH. Performance on TOMI and VMI (even in those without disabling impairments) was poorer in those with VD and GMH-IVH than in children with normal scans or those with VD only. Children with VD and GMH-IVH had significantly lower performance IQ than children with normal ultrasound, whereas those with VD only were not different from those with normal scans. Results suggest the presence of subtle white matter injury that has not been identified by neonatal cranial ultrasound. Although this study did not investigate biochemical markers of haemorrhage, we hypothesize that non-proteinbound iron is likely to be a contributing factor to white matter damage in preterm infants.

Intraventricular Hemorrhage and Neurodevelopmental Outcomes in Extreme Preterm Infants

“…2 Grade III-IV IVH and other lesions noted on ultrasound including periventricular leukomalacia (PVL), porencephaly, and ventriculomegaly are well documented to be associated with adverse neurodevelopmental outcomes. [3][4][5][6][7] However, the true impact of lower-grade IVH on the neurodevelopment of these extreme preterm infants has not been well described. IVH originates in the germinal matrix, which is the source of future neuronal and glial cells in the immature brain.…”

Periventricular/Intraventricular Hemorrhage and Neurodevelopmental Outcomes: A Meta-analysis

“…This process resulted in 20 studies deemed eligible for inclusion. [14][15][16]19,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Additionally, 1 study 43 was identified and deemed eligible through searching references of included studies, bringing the final total to 21. Baseline characteristics of the 21 included studies are as shown in Supplemental Information 2.…”

Destruction and reconstruction: Hypoxia and the developing brain

“…Postmortem data shows SVZ damage in at least some infants exposed to severe hypoxia (Takizawa et al, 2006), and there is some evidence that hemorrhage in the SVZ is associated with worse neurodevelopmental outcomes (Vollmer et al, 2006). Experimentally, exposure to prolonged, severe hypoxia in preterm fetal sheep at 0.6 of gestation (equivalent to the 26-to 30-week human infant) (McIntosh et al, 1979) was associated with extensive cell death in the SVZ despite sparing of the cortex .…”