Original article
Grades I-II intraventricular hemorrhage in extremely low birth weight infants: Effects on neurodevelopment

https://doi.org/10.1016/j.jpeds.2006.04.002Get rights and content

Objective

To quantify the effect of grades I-II intraventricular hemorrhage (IVH) on the neurosensory and cognitive outcomes of extremely low birth weight infants.

Study design

Of 706 extremely low birth weight infants without major malformations admitted to our center from 1992 to 2000, 537 survived to 20 months’ corrected age (CA) and had cranial ultrasound studies performed, of whom 490 (91%) had complete neurodevelopmental assessments. Infants with severe cranial ultrasound abnormalities or meningitis were excluded, leaving a population of 362 infants, 258 of whom had a normal cranial ultrasound and 104 had an isolated grade I-II IVH. The groups had similar birth weight (808 vs 801 grams) and gestational age (26.5 vs 26.3 weeks). Outcomes of infants with normal cranial ultrasound were compared with those with grades I-II IVH at 20 months’ CA. Outcomes included the Bayley Scales of Infant Development Mental Developmental Index (MDI) and major neurosensory abnormality. Logistic regression was used to assess the effect of grades I-II IVH on outcomes while adjusting for other risk factors.

Results

Extremely low birth weight infants with grades I-II IVH had a significantly lower mean MDI score than infants with normal cranial ultrasound (74 ± 16 vs 79 ± 14, P = .006). They had higher rates of MDI <<70 (45% vs 25%; OR, 2.00; 95% CI, 1.20 to 3.30; P = .008), major neurologic abnormality (13% vs 5%; OR, 2.60; 95% CI, 1.06 to 6.36; P = .036), and neurodevelopmental impairment (47% vs 28%; OR, 1.83; 95% CI, 1.11 to 3.03; P = .018) at 20 months’ CA, even when adjusting for confounding factors.

Conclusions

Extremely low birth weight infants with grades I-II IVH have poorer neurodevelopmental outcomes at 20 months’ CA than infants with normal cranial ultrasound. Advanced radiologic imaging may indicate additional brain injury associated with grade I-II IVH, which could explain these outcomes.

Section snippets

Methods

Seven hundred six ELBW infants without major congenital malformations were admitted to the neonatal intensive care unit at Rainbow Babies and Children’s Hospital in Cleveland, Ohio, from January 1, 1992, through December 31, 2000. Five hundred thirty-seven survived to 20 months’ CA and had cranial ultrasound studies performed during the hospital course, of whom 490 (91%) had complete neurodevelopmental assessments at that time. The protocol for cranial ultrasound screening of ELBW infants

Results

A comparison of maternal sociodemographic data and perinatal and neonatal risk factors between infants with a normal cranial ultrasound and those with grade I-II IVH is given in Table I. Significantly more mothers of infants with grade I-II IVH were unmarried and black compared with mothers of infants with a normal cranial ultrasound. The mothers of infants with grades I-II IVH also had lower rates of antenatal steroid therapy and delivery by cesarean section. Infants with grade I-II IVH had

Discussion

Our study indicates that ELBW infants born since 1992 with grades I-II IVH have significantly poorer neurodevelopmental outcomes at 20 months’ CA compared with ELBW infants with a normal cranial ultrasound, even after adjusting for confounding factors. Poorer outcomes included higher rates of major neurologic abnormality and deafness and poorer cognitive development, as evidenced by lower mean MDI scores and higher rates of subnormal MDI.

Most studies that have examined the effects of grades

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  • Cited by (0)

    Supported by grant M01 RR00080, General Clinical Research Center of the National Institutes of Health.

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