Neurodevelopmental Outcome in Children With Intraventricular Hemorrhage

doi:10.1016/j.pediatrneurol.2005.08.011

Pediatric Neurology

Volume 34, Issue 3, March 2006, Pages 219-224

https://doi.org/10.1016/j.pediatrneurol.2005.08.011 Get rights and content

To clarify the neurodevelopmental outcome in children with intraventricular hemorrhage, a follow-up study was performed for a consecutive group of 335 subjects in one tertiary center born between 1981 and 1999. Their mean gestation and birth weight were 28.1 weeks and 1162.2 gm, respectively. The follow-up period ranged from 3 to 20 years (mean: 7.5 years). The neurodevelopmental outcomes were normal in 188 (56.1%), cerebral palsy in 75 (22.4%), mental retardation in 34 (10.2%), and borderline intelligence in 38 (11.3%). There were statistically significant differences in the outcomes among the groups with different grades of intraventricular hemorrhage. Approximately 70% of the children with intraventricular hemorrhage grade 1 were normal, whereas only 15.4% of the children with intraventricular hemorrhage grade 4 were normal. Cerebral palsy was associated with as high as 71.2% in the patients with intraventricular hemorrhage grade 4. The overall incidence of epilepsy was 39/335 (11.6%). This study has not demonstrated clear improvement of the outcome in children with intraventricular hemorrhage between the 1980s and 1990s.

Introduction

Over the past two decades, the incidence of intraventricular hemorrhage in preterm infants has been declining with advances in perinatal medicine [1], [2], whereas the prevalence of intraventricular hemorrhage is suggested to have remained unchanged or even be increasing owing to a greater likelihood of survival in very low birth weight infants [3], [4], [5], [6], [7].

With such trends of epidemiologic variables, however, it is not clear whether or not the neurodevelopmental outcome in children with intraventricular hemorrhage has improved in parallel with the declining incidence of intraventricular hemorrhage. For follow-up examination of children with a specific risk factor, knowledge allowing an overview of the outcome in that group is helpful in evaluating the children. The purpose of this study was to clarify the neurodevelopmental outcome in children with intraventricular hemorrhage in a series comprising a large number of subjects from one tertiary center, including recent cases, and thereby to obtain useful information for evaluating the outcomes in children with intraventricular hemorrhage currently being monitored.

Section snippets

Materials and Methods

A total of 575 infants (308 males, 267 females) with intraventricular hemorrhage admitted to the neonatal intensive care unit of our center between November 1981 and May 1999 were analyzed as to mortality and morbidity. Their intraventricular hemorrhage was first detected on routine cranial ultrasound examination by neonatologists, and then confirmed in detail by cranial computed tomography, if the infants were in a suitable condition to undergo computed tomography. Routine cranial ultrasound

Results

Table 1 lists the total number of cases with intraventricular hemorrhage in this study. The numbers of cases with intraventricular hemorrhage grades 1 through 4 were 177, 204, 59, and 135, respectively. There were no statistically significant differences in the sex, inborn/outborn ratio, or mean birth weight among the groups with different grades of intraventricular hemorrhage, whereas the mean gestation in the infants with grade 4 intraventricular hemorrhage was significantly lower than those

Discussion

Although surfactant therapy was introduced in our hospital in 1987, our previous study indicated that there was no difference in the incidence of intraventricular hemorrhage for infants with birth weights of less than 1000 gm between the periods before (1981-1986) and after (1989-1993) introduction of the therapy. Accordingly, we could not prove that the use of a surfactant had directly facilitated the prevention of intraventricular hemorrhage [5].

As previous studies have already demonstrated

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Despite advances in neonatal care and overall improved survival rates of preterm infants, intraventricular haemorrhage (IVH) remains an important cause of mortality and long-term neurodevelopmental morbidity in the preterm population. Counselling parents regarding possible outcomes following IVH can be very challenging, particularly as prognostication can be difficult in the early stages. This article gives an overview of the incidence, pathophysiology, clinical manifestations, treatment and classification of IVH. In addition, it reviews the currently available outcome data following IVH including recent publications on less severe IVH previously not thought to be of particular clinical significance. It includes best practice recommendations for parental discussions and decision-making.
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Original articleNeurodevelopmental Outcome in Children With Intraventricular Hemorrhage

Introduction

Section snippets

Materials and Methods

Results

Discussion

Neurol Clin North Am

Brain Dev

Early Hum Dev

J Pediatr

Early Hum Dev

Early Hum Dev

Eur J Obstet Gynecol Reprod Biol

Clin Perinatol

Semin Perinatol

Intracranial hemorrhageGerminal matrix-intraventricular hemorrhage of the premature infant

Outcome of infants weighing less than 800 grams at birth15 years’ experience

Pediatrics

Outcomes of extremely low birth weight infants

Pediatrics

Posthemorrhagic hydrocephalus of infancy

Neurosurg Clin North Am

Terminology and classification of cerebral palsy

Dev Med Child Neurol

Posthaemorrhagic ventricular dilatation in the premature infantNatural history and predictors of outcome

Arch Dis Child Neonatal Ed

Original article
Neurodevelopmental Outcome in Children With Intraventricular Hemorrhage