Abstract
AIMS: To evaluate the impact of low-grade intraventricular hemorrhage on neurodevelopmental outcome in preterm infants at 24 months of age.METHODS: We conducted a retrospective case-control study of infants with gestational age less than 34 weeks, admitted to a Neonatal Intensive Care Unit between January/2006 and December/2015. Cases were defined as those with low-grade intraventricular hemorrhage (grades I or II), diagnosed by cranial ultrasonography. For each case, a control with the same gestational age but without intraventricular hemorrhage was selected. Follow-up examinations of neurodevelopment were performed at 24 months of age in cases and controls using the Griffiths Mental Development Scale. Cerebral palsy, neurodevelopmental delay (developmental quotient <2 side deviations below the mean), hearing impairment and/or blindness were considered as severe neurodevelopmental impairment.RESULTS: The study included 172 preterm infants: 86 cases and 86 controls. In the univariate analysis, a difference between the two groups was identified for the following clinical findings: antenatal corticosteroid complete cycle (57% in cases vs. 80% in controls; p=0.001; OR: 0.33, 95%CI 0.17-0.64); male gender (63% cases vs. 41% controls; p=0.004; OR: 2.45, 95%CI 1.3-4.5); outborn (26% cases vs. 9% controls; p=0.005; OR: 3.3 95%CI 1.4-8.0); Clinical Risk Index for Babies higher than 5 (24% in cases vs. 12% in controls; p=0.029; OR: 2.4 95%CI 1.1-5.6); intubation in the delivery room (47% cases vs. 27% controls; p=0.007; OR: 2.38 95%CI 1.3-4.5); and neonatal sepsis (34% in cases vs. 20% in controls; p=0.039; OR: 2.1 95%CI 1.03-4.1). After logistic regression, differences were only maintained for antenatal corticosteroid (p=0.005; OR 0.34, 95%CI 0.16-0.72) and male gender (p=0.002; OR 2.9, 95%CI 1.4-5.8). A severe neurodevelopmental deficit was present in three cases (3.5%) and one control (1.2%). No statistically significant differences in outcome were found between cases and controls.CONCLUSIONS: In this sample, preterm infants with low-grade intraventricular hemorrhage diagnosed by cranial ultrasonography had no difference in early neurodevelopmental outcome when compared with controls.
Highlights
Due to the advances in prenatal and neonatal medicine, survival rates of preterm infants are increasing within the last decades
Of 880 preterm infants with less than 34 weeks of gestational age admitted in the neonatal intensive care unit (NICU), 112 infants had low-grade Intraventricular hemorrhage (IVH), the incidence of IVH was 12.7%, being 8.5% grade I and 4.2% grade II
We found a positive association between low-grade IVH and antenatal corticosteroid complete cycle (p=0.001), male gender (p=0.004), outborn (p=0.005), Clinical Risk Index for Babies (CRIB)>5 (p=0.029), intubation in the delivery room (p=0.007), and neonatal sepsis (p=0.039)
Summary
Due to the advances in prenatal and neonatal medicine, survival rates of preterm infants are increasing within the last decades. This group is at high risk for developing severe complications. Its incidence has decreased during the last decades, IVH remains a significant problem because of the greater number of survivors with this condition [1,2,3]. Risk for IVH increases with decreasing gestational age and birth weight, being inversely related to infant maturity [2]. Recent multicenter epidemiological studies reported an incidence rate of IVH of 25-30% for very low birth weight infants and even higher for extreme low birth weight infant [4, 5]. The described rate for low-grade IVH (grades I-II) is 11% and for severe IVH (grades III-IV) is 3-5% [4, 6, 7]
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