The Impact of Different Degrees of Intraventricular Hemorrhage on Mortality and Neurological Outcomes in Very Preterm Infants: A Prospective Cohort Study

Abstract

ObjectiveIntraventricular hemorrhage (IVH) is a common complication in preterm infants and is related to neurodevelopmental outcomes. Infants with severe IVH are at higher risk of adverse neurological outcomes and death, but the effect of low-grade IVH remains controversial. The purpose of this study was to evaluate the impact of different degrees of IVH on mortality and neurodevelopmental outcomes in very preterm infants.MethodsPreterm infants with a gestational age of <30 weeks admitted to neonatal intensive care units were included. Cerebral ultrasound was examined repeatedly until discharge or death. All infants were followed up to 18–24 months of corrected age. The impact of different grades of IVH on death and neurodevelopmental disability was assessed by multiple logistic regression.ResultsA total of 1,079 preterm infants were included, and 380 (35.2%) infants had grade I-II IVH, 74 (6.9%) infants had grade III-IV IVH, and 625 (57.9%) infants did not have IVH. The mortality in the non-IVH, I-II IVH, and III-IV IVH groups was 20.1, 19.7, and 55.2%, respectively (p < 0.05), and the incidence of neurodevelopmental disabilities was 13.9, 16.1, and 43.3%, respectively (p < 0.05), at 18–24 months of corrected age. After adjusting for confounding factors, preterm infants with III-IV IVH had higher rates of cerebral palsy [26.7 vs. 2.4%, OR = 6.10, 95% CI (1.840–20.231), p = 0.003], disability [43.3 vs. 13.9%, OR = 2.49, 95% CI (1.059–5.873), p = 0.037], death [55.2 vs. 20.1%, OR = 3.84, 95% CI (2.090–7.067), p < 0.001], and disability + death [73.7 vs. 28.7%, OR = 4.77, 95% CI (2.518–9.021), p < 0.001] compared to those without IVH. However, the mortality and the incidence of neurodevelopmental disability in infants with I-II IVH were similar to those without IVH (p > 0.05).ConclusionsSevere IVH but not mild IVH increased the risk of mortality and neurodevelopmental disability in very preterm infants.

Intraventricular haemorrhage in premature infants. Review of diagnostic methods, treatment and influence on neurodevelopment

“…The same outcome concerns grade III-IV of haemorrhage and other lesions noted on ultrasound including periventricular leukomalacia, porencephaly and ventriculomegaly [12]. On the other hand, Yong Wang's study indicated that preterm infants of <30 weeks' gestational age with I-II grade of haemorrhage had similar neurological outcomes and mortality compared to those without intraventricular haemorrhage, while III-IV grade was associated with cerebral palsy, disability and death at 18-24 months of corrected age [13].…”

Grading of Intraventricular Hemorrhage and Neurodevelopment in Preterm <29 Weeks’ GA in Canada

“…In contrast, several studies suggest that mild IVH is not an independent factor for adverse neurodevelopmental outcomes [ 8 , 9 ]. Variations in the reported outcomes between our study and those reported in the literature could be attributed to a number of factors, including a single-center study, the type of study population (including infants with a higher GA who are at a lower risk of IVH), and sample size.…”

“…The grading of IVH is used by clinicians to predict neurodevelopmental outcomes and to counsel families; however, there is no consensus in the literature regarding the impact of grades I–II IVHs and neurodevelopmental outcomes [ 3 , 5 , 6 ]. Some studies suggest that grades I–II IVHs are benign and have outcomes comparable to those with normal head ultrasound findings [ 7 , 8 , 9 ]. On the other hand, there are several studies that have reported adverse outcomes with these “minor” hemorrhages [ 5 , 10 , 11 , 12 , 13 ].…”

Sustained acute kidney injury as an independent risk factor for neurodevelopmental and growth outcomes in a single NICU center

“…In this context, a brain insult is defined as perinatal asphyxia, which may occur with or without resuscitation and with or without hypoxic-ischemic encephalopathy. Regarding the severity of IVH, using the Papile classification, grades III and IV are classified as severe [ 23 , 24 ].…”