Periventricular Hemorrhagic Infarction: Risk Factors and Neonatal Outcome

Abstract

The aim of this study was to define the incidence, clinical associations, and short-term outcome of periventricular hemorrhagic infarction in the modern neonatal intensive care unit. From 5774 infants (birth weight<2500 gm), periventricular hemorrhagic infarction diagnosed by cranial ultrasound was identified and confirmed. gestational age-matched control infants were identified with normal cranial ultrasounds and detailed clinical data were obtained in both groups. Periventricular hemorrhagic infarction was confirmed in 58 infants. Incidence was 0.1% (1500-2500 gm), 2.2% (750-1500 gm), and 10% (<750 gm). Data across 6 study years reveal increased incidence in infants<750 gm. Compared with control infants, infants with periventricular hemorrhagic infarction had significantly greater association with assisted conception, intrapartum factors (emergency cesarean section, low Apgar scores), early neonatal complications (patent ductus arteriosus, pneumothorax, pulmonary hemorrhage), blood gas disturbances, and need for pressor, volume infusion, and respiratory support. Neonatal mortality of this group was 40% (n=23). Survivors had longer duration of mechanical ventilation and critical care stay compared with control subjects. Thirty-seven percent of survivors required cerebrospinal fluid shunt placement. Periventricular hemorrhagic infarction remains an important neurologic complication of prematurity. A growing population of survivors is apparent among infants with birth weight<750 gm. Multiple hemodynamic factors associated with periventricular hemorrhagic infarction cluster in the intrapartum and early neonatal periods.