IS THE LONG TERM OUTCOME OF VLBW INFANTS WITH GRADE IV INTRAVENTRICULAR HEMORRHAGE UNIFORMLY POOR? • 1555

Abstract

Purpose: This study compared perinatal factors and short and long term outcomes of infants with Gr IV intraventricular hemorrhage (IVH) in relation to those with Gr II-III IVH (Papile classification).Methods: The target population was all 632, 500-1250 g birthweight infants born in Southern Alberta between 1987 and 1992. The infants had cranial ultrasound examinations in the first two weeks of life, then biweekly until discharge; 29 infants had Gr IV IVH and 54 had Gr II-III IVH. Demographic and perinatal factors and follow-up results determined at or near 36 months adjusted age were compared in the two groups. Results: The perinatal factors found more frequently in infants with gr IV IVH were neonatal transport (31% vs. 11.1%, p =.025), multiple birth (31% vs. 18.6%, p=.196), breech presentation (37% vs. 25.9%, p =.302) and prolonged acidosis(51.2% vs. 25.9%, p =.019). The groups did not differ in birthweight (844 g vs. 826 g, p =.202) or gestational age (26.2% vs. 25.8%, p =.276), but Caesarian section rates were higher in the Gr IV group (48.3% vs. 20.4%, p=.008). The mortality rate in infants with Gr IV IVH was (55.7%) and in the infants with Gr II-III IVH it was (27.7%). Surprisingly, infants with Gr IV IVH had shorter duration of ventilation (15.2 days vs. 31.5 days, p =.002) and oxygen therapy (30.9 days vs. 62.4 days, p =.001). In follow-up, 6/11 (45.5%) of the infants with Gr IV IVH were non-disabled, compared to 13/38 (65.0%) infants with Gr II-III IVH. The frequency of cognitive delay, blindness, cerebral palsy, deafness and seizure disorder were similar in the two groups.Conclusion: The outcomes of 500-1250 g infants with Gr IV IVH are not uniformly poor since 45.5% are non-disabled. Implications: Parents and caregivers should be aware that there is a possibility of survival without disability in the present of Gr IV IVH. The occurrence of isolated Gr IV IVH should not be considered as a sufficient criterion for discontinuation of care.