Risk For Abnormal Neurodevelopmental Outcome Research Articles

Neurodevelopmental outcomes in children exposed prenatally to levetiracetam.

Some old antiseizure medications (ASMs) pose teratogenic risks, including major congenital malformations and neurodevelopmental delay. Therefore, the use of new ASMs in pregnancy is increasing, particularly lamotrigine and levetiracetam. This is likely due to evidence of low risk of anatomical teratogenicity for both lamotrigine and levetiracetam. Regarding neurodevelopmental effects, lamotrigine is the most frequently investigated new ASM with information available for children up to 14 years of age. However, fewer data are available for the effects of levetiracetam on cognitive and behavioral development, with smaller cohorts and shorter follow-up. The aim of the present review was to explicate neurodevelopmental outcomes in children exposed prenatally to levetiracetam to support clinical decision-making. The available data do not indicate an increased risk of abnormal neurodevelopmental outcomes in children exposed prenatally to levetiracetam. Findings demonstrated comparable outcomes for levetiracetam versus controls and favorable outcomes for levetiracetam versus valproate on global and specific cognitive abilities, and behavioral problems. In addition, the available evidence shows no significant dose-effect association for levetiracetam on neurodevelopmental outcomes. However, this evidence cannot be determined definitively due to the limited numbers of exposures with relatively short follow-up. Therefore, further research is required.Plain Language SummaryAntiseizure medications (ASMs) are medicines that inhibit the occurrence of seizures. Levetiracetam is a new ASM. Some old ASMs are linked with an increased risk of physical birth abnormalities and adverse effects on the child’s brain development. Therefore, the use of new ASMs in pregnancy is increasing, especially lamotrigine and levetiracetam. This is likely due to evidence of low risk of birth abnormalities for both lamotrigine and levetiracetam. Regarding effects on development of the brain, lamotrigine is the most frequently examined new ASM with information available for children up to 14 years of age. However, fewer data are available for the effects of levetiracetam on cognitive and behavioral development. Also, levetiracetam studies were smaller and shorter compared with studies investigating lamotrigine effects. The aim of this article was to review the child’s brain development effects after exposure to levetiracetam during pregnancy. The available data do not suggest an increased risk of the child having learning or thinking difficulties. Findings demonstrated comparable outcomes for levetiracetam versus controls (i.e. children unexposed to levetiracetam), and favorable outcomes for levetiracetam versus valproate. In addition, the available evidence shows no link between the higher dose of levetiracetam and an increased risk of adverse effects on the child’s brain development. However, this evidence cannot be determined definitively due to the limited numbers of children exposed to levetiracetam with relatively short duration of follow-up. Therefore, further research is required.

Inflammatory and vascular placental lesions are associated with neonatal amplitude integrated EEG recording in early premature neonates.

IntroductionPlacental histologic examination can assist in revealing the mechanism leading to preterm birth. Accumulating evidence suggests an association between intrauterine pathological processes, morbidity and mortality of premature infants, and their long term outcome. Neonatal brain activity is increasingly monitored in neonatal intensive care units by amplitude integrated EEG (aEEG) and indices of background activity and sleep cycling patterns were correlated with long term outcome. We hypothesized an association between types of placental lesions and abnormal neonatal aEEG patterns.ObjectiveTo determine the association between the placental lesions observed in extreme preterm deliveries, and their neonatal aEEG patterns and survival.Patients and methodsThis prospective cohort study included extreme premature infants, who were born ≤ 28 weeks of gestation, their placentas were available for histologic examination, and had a continues aEEG, soon after birth)n = 34). Infants and maternal clinical data were collected. aEEG data was assessed for percentage of depressed daily activity in the first 3 days of life and for sleep cycling. Associations of placental histology with clinical findings and aEEG activity were explored using parametric and non-parametric statistics.ResultsTwenty two out of the 34 newborns survived to discharge. Preterm prelabor rupture of membranes (PPROM) or chorioamnionitis were associated with placental lesions consistent with fetal amniotic fluid infection (AFI) or maternal under perfusion (MUP) (P < 0.05). Lesions consistent with fetal response to AFI were associated with absence of SWC pattern during the 1st day of life. Fetal-vascular-thrombo-occlusive lesions of inflammatory type were negatively associated with depressed cerebral activity during the 1st day of life, and with aEEG cycling during the 2nd day of life (P<0.05). Placental lesions associated with MUP were associated with depressed neonatal cerebral activity during the first 3 days of life (P = 0.007).ConclusionsDepressed neonatal aEEG patterns are associated with placental lesions consistent with maternal under perfusion, and amniotic fluid infection of fetal type, but not with fetal thrombo-oclusive vascular disease of inflammatory type. Our findings highlight the association between the intrauterine mechanisms leading to preterm parturition and subsequent depressed neonatal cerebral function early after birth, which eventually may put premature infants at risk for abnormal neurodevelopmental outcome.

Cognitive development in preterm infants: multifaceted deficits reflect vulnerability of rigorous neurodevelopmental pathways.

Prematurity remains the major cause of neonatal morbidity and mortality, with 15 million preterm births occurring worldwide in 2010. Infants born less than 37 weeks gestation are at high risk of abnormal neurodevelopmental outcomes, given that the central nervous system is extremely sensitive to an abnormal intra- and extra-uterine environment. Children born preterm have multiple neurodevelopmental sequelae involving dynamic and complex cognitive deficits. Former preterm infants have difficulty with each domain of cognition, including executive function, language, learning and memory, complex attention, perceptual-motor function and social cognition when compared to children born at term. Although deficits are not always severe, even mild delays can be impactful, resulting in a spectrum of outcomes from difficulties in school to an inability to lead an independent adult life. Here, we review current literature on the cognitive outcomes of infants born preterm with a focus on how specific disruption in crucial neurodevelopmental pathways render these children vulnerable to dynamic deficits in cognition as they mature. Further, we highlight promising therapies and intervention strategies aimed at mitigating these deficits, including the use of erythropoietin. With an increasing number of preterm infants surviving, understanding developmental deficits will allow therapies to be developed and optimized, in order to ensure the best outcome for this vulnerable patient population.

Isolated Cystic Periventricular Leukomalacia Differs from Cystic Periventricular Leukomalacia with Intraventricular Hemorrhage in Prevalence, Risk Factors and Outcomes in Preterm Infants

Background: Cystic periventricular leukomalacia (cPVL) is the most severe white matter injury and is often associated with intraventricular hemorrhage (IVH) in preterm infants. Objective: The aim of this study was to investigate the prevalence, risk factors and neurodevelopmental outcomes of isolated cPVL and cPVL with low-grade and high-grade IVH in premature infants. Methods: From 2001 to 2012, 9,964 infants with <31 weeks' gestational age (GA) admitted to Taiwan hospitals were enrolled. cPVL was classified into three groups: isolated cPVL, cPVL with low-grade (I/II) IVH, and cPVL with high-grade (III) IVH. Results: Of 7,805 infants with complete ultrasound data, 286 (3.7%) had cPVL. Among the cPVL infants, 93 (32.5%) were isolated, 118 (41.3%) had low-grade IVH and 75 (26.2%) had high-grade IVH. The risk of cPVL with IVH was significantly higher among infants with <27 weeks' GA than those with ≥27 weeks' GA, in contrast to that of isolated cPVL. Using infants without cPVL and IVH as the reference group, the most significant predictor of isolated cPVL was neonatal sepsis (odds ratio 2.39; 95% confidence interval 1.52-3.77), while 5-min Apgar score <5 (2.50; 1.48-4.21) and prolonged mechanical ventilation (2.19; 1.42-3.42) were associated with cPVL with low-grade IVH, and GA <27 weeks (2.63; 1.56-4.42), pneumothorax (3.04; 1.40-6.65) and prolonged mechanical ventilation (3.36; 1.88-6.01) contributed to cPVL with high-grade IVH. cPVL infants with low-grade and high-grade IVH had a higher risk of abnormal neurodevelopmental outcomes than infants with isolated cPVL at the age of 24 months. Conclusions: Isolated cPVL, cPVL with low-grade IVH and cPVL with high-grade IVH had different risk factors and neurodevelopmental outcomes, suggestive of different causal pathways.

Systematic review and meta-analysis of isolated posterior fossa malformations on prenatal imaging (part 2): neurodevelopmental outcome.

Diagnosis of isolated posterior fossa anomalies in children is biased by the fact that only those that are symptomatic are brought to the attention of the appropriate clinical personnel, and the reported rate is often affected by the adoption of different nomenclature, diagnostic criteria, outcome measures, duration of follow-up and neurodevelopmental tools. The aim of this systematic review was to explore the neurodevelopmental outcome of fetuses with a prenatal diagnosis of isolated posterior fossa anomalies. MEDLINE and EMBASE were searched electronically, utilizing combinations of the relevant medical subject heading terms for 'posterior fossa' and 'outcome'. Studies assessing the neurodevelopmental outcome in children with a prenatal diagnosis of isolated posterior fossa malformations were considered eligible. The posterior fossa anomalies analyzed included Dandy-Walker malformation (DWM), mega cisterna magna (MCM), Blake's pouch cyst (BPC) and vermian hypoplasia (VH). Two authors reviewed all abstracts independently. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale for cohort studies. Meta-analyses of proportions were used to combine data, and between-study heterogeneity was explored using the I(2) statistic. A total of 1640 articles were identified; 95 were assessed for eligibility and a total of 16 studies were included in the systematic review. The overall rate of abnormal neurodevelopmental outcome in children with a prenatal diagnosis of DWM was 58.2% (95% CI, 21.8-90.0%) and varied from 0-100%. In those with a prenatal diagnosis of MCM, the rate of abnormal neurodevelopmental outcome was 13.8% (95% CI, 7.3-21.9%), with a range of 0-50%. There was no significant association between BPC and the occurrence of abnormal neurodevelopmental delay, with a rate of 4.7% (95% CI, 0.7-12.1%) and range of 0-5%. Although affected by the very small number of studies, there was a non-significant occurrence of abnormal neurodevelopmental delay in children with a prenatal diagnosis of VH, with a rate of 30.7% (95% CI, 0.6-79.1%) and range of 0-100%. Fetuses diagnosed with isolated DWM are at high risk of abnormal neurodevelopmental outcome, while isolated MCM or BPC have a generally favorable outcome. The risk of abnormal developmental delay in cases with isolated VH needs to be further assessed. In view of the wide heterogeneity in study design, time of follow-up, neurodevelopmental tests used and the very small number of included cases, further future large prospective studies with standardized and objective protocols for diagnosis and follow-up are needed in order to ascertain the rate of abnormal neurodevelopmental outcome in children with isolated posterior fossa anomalies. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

The Association between Sucking Behavior in Preterm Infants and Neurodevelopmental Outcomes at 2 Years of Age

To evaluate whether a specific period after birth (in weeks postmenstrual age [PMA]) and specific elements of sucking are associated with abnormal neurodevelopmental outcomes at age 2 years using a longitudinal approach. Fifty-two preterm infants participated in this longitudinal cohort study (mean gestational age, 29.5 weeks; mean birth weight, 1197 g). We assessed the infants' sucking patterns at 37-50 weeks PMA using the Neonatal Oral-Motor Assessment Scale. At age 2 years, based on a neurologic examination and the Dutch version of the Bayley Scales of Infant and Toddler Development, Second Edition, we categorized the children as developing normally (n = 39) or abnormally (n = 13). ORs, including 95% CIs, were calculated to ascertain the risk of abnormal neurodevelopmental outcomes. The inability to sustain sucking at 46 weeks PMA (OR, 6.25; 95% CI, 1.29-30.35) and the absence of a mature sucking pattern at 44 weeks PMA (OR, 6.30; 95% CI, 1.40-28.32) significantly increased the odds of abnormal neurodevelopmental outcomes at age 2 years. The ORs of the Neonatal Oral-Motor Assessment Scale items assessing rhythmic jaw movements, rhythmic tongue movements, and coordination among sucking, swallowing, and respiration were high shortly after term, but failed to reach significance. Specific elements of sucking at 4-6 weeks postterm are associated with abnormal neurodevelopmental outcomes in preterm infants at age 2 years. This period might be a sensitive time of infant development in which sucking behavior is an early marker of abnormal developmental outcomes. This finding may offer opportunities for early intervention.

Neurodevelopmental outcomes of near-term small-for-gestational-age infants with and without signs of placental underperfusion

ObjectiveTo evaluate 2-year neurodevelopmental outcomes of near-term, small-for-gestational-age (SGA) newborns segregated by presence or absence of histopathology reflecting placental underperfusion (PUP). Patients and methodsA cohort of consecutive near-term (≥34.0 weeks) SGA newborns with normal prenatal umbilical artery Doppler studies was selected. All placentas were inspected for evidence of underperfusion and classified in accordance with established histologic criteria. Neurodevelopmental outcomes at 24 months (age-corrected) were then evaluated, applying the Bayley Scale for Infant and Toddler Development, Third Edition (Bayley-III) to assess cognitive, language, and motor competencies. The impact of PUP on each domain was measured via analysis of covariance, logistic and ordinal regression, with adjustment for smoking, socioeconomic status, gestational age at birth, gender, and breastfeeding. ResultsA total of 83 near-term SGA deliveries were studied, 46 (55.4%) of which showed signs of PUP. At 2 years, adjusted neurodevelopmental outcomes were significantly poorer in births involving PUP (relative to SGA infants without PUP) for all three domains of the Bayley scale: cognitive (105.5 vs 96.3, adjusted-p = 0.03), language (98.6 vs 87.8, adjusted-p<0.001), and motor (102.7 vs 94.5, adjusted-p = 0.007). Similarly, the adjusted likelihood of abnormal cognitive, language, and motor competencies in instances of underperfusion was 9.3-, 17.5-, and 1.44-fold higher, respectively, differing significantly for the former two domains. ConclusionsIn a substantial fraction of near-term SGA babies without Doppler evidence of placental insufficiency, histologic changes compatible with PUP are still identifiable. These infants are at greater risk of abnormal neurodevelopmental outcomes at 2 years.

Two-year outcomes for infants with low cord pH at birth

Objective: To determine the long-term outcome of infants born with cord pH ≤ 7.0 and no clinical evidence of asphyxia at birth.Design: Setting: Tertiary Referral Centre. A prospective matched cohort study was conducted. 51 term infants were recruited following singleton birth with venous cord pH ≤ 7.0. For each recruited baby a healthy baby with normal cord pH ≥ 7.20 was recruited matched for gestation, gender and mode of delivery. Ages and Stages Questionnaires (ASQ)TM and Health Screening Questionnaires (HSQ) were sent out at 24 months of age. Two independent assessors, blinded to the case assignment, reviewed intrapartum and neonatal events to look for clinical evidence of birth asphyxia among the cases.Result: From 102 infants recruited, 62 questionnaires (24 cases, 38 controls) were returned. 20 matched pairs with no clinical evidence of birth asphyxia were available for analysis. The groups were similar except in terms of birth weight; the pH ≥ 7.0 group had mean birth weight 584 g lower than controls (p = 0.005). The ASQ motor scores were lower in children born with low cord pH (p = 0.019); however, once adjusted for birth weight, the difference was not significant (p = 0.289).Conclusion: It is unlikely that abnormal cord pH in otherwise healthy neonates leads to a substantially increased risk of abnormal neurodevelopmental outcome or severe health problems by 2 years of age.

OP13.01: Cerebral blood flow redistribution in fetuses with congenital heart disease

Congenital heart disease (CHD) is known to be associated to and increased risk of abnormal neurodevelopmental outcome, even in the absence of surgical intervention. Recent studies have established a strong link between fetal arterial redistribution and poorer neurodevelopmental outcome after birth. The aim of this study was to explore cerebral blood flow perfusion in fetuses with CHD during the third trimester of pregnancy. Retrospective case series of fetuses with a diagnosis of major CHD. Fetuses affected by placental insufficiency were excluded. Middle cerebral artery (MCA) and cerebro-placental ratio (CPR), expressed as the ratio between MCA and umbilical artery (UA) PI, were analysed in patients with CHD from 28 weeks of gestation. The proportion of fetuses with abnormal MCA PI or CPR, defined as below the 5th centile for a given gestational age, was calculated and the distribution of abnormal Doppler finding among different types of CHD was analysed using Chi-square test for trend. 132 normally grown fetuses with CHD were included in the analysis. The proportion of fetuses with abnormal Doppler findings, expressed MCA or CPR <5th centile, was 62.41% (95% confidence intervals, C.I. 53.9%-70.2%). Signs of brain redistribution were present in 46.15% (95% C.I. 23.2%-70.1%) of fetuses with AVSD, 61.54% (95% C.I. 45.7%-75.1%) in cases with VSD, in 66.67% (95% C.I. 46.2-82.2) of the cases of cono-truncal abnormalities, 72.41% (95% C.I. 54.1-85.5) of cases with obstruction of the right or left outflow tracts and in 30.00% (95% C.I. 10.3-70.8) in fetuses with transposition of the great arteries with a significant statistical difference among the different categories of CHD (p = 0.0002). Normally grown fetuses with CHD have a higher than expected rate of redistribution of cerebral blood flow in the absence of placental insufficiency. This finding suggests a possible pathophysiological mechanism for the high rate of neurodevelopmental outcome observed in these patients.

Neurodevelopmental Outcomes Following Two Different Treatment Approaches (Early Ligation and Selective Ligation) for Patent Ductus Arteriosus

To examine whether a change in the approach to managing persistent patent ductus arteriosus (PDA) from early ligation to selective ligation is associated with an increased risk of abnormal neurodevelopmental outcomes. In 2005, we changed our PDA treatment protocol for infants born at ≤27 6/7 weeks' gestation from an early ligation approach, with prompt PDA ligation if the ductus failed to close after indomethacin therapy (period 1: January 1999 to December 2004), to a selective ligation approach, with PDA ligation performed only if specific criteria were met (period 2: January 2005 to May 2009). All infants in both periods received prophylactic indomethacin. Multivariate analysis was used to compare the odds of a composite abnormal neurodevelopmental outcome (Bayley Mental Developmental Index or Cognitive Score <70, cerebral palsy, blindness, and/or deafness) associated with each treatment approach at age 18-36 months (n = 224). During period 1, 23% of the infants in follow-up failed indomethacin treatment, and all underwent surgical ligation. During period 2, 30% of infants failed indomethacin, and 66% underwent ligation after meeting prespecified criteria. Infants treated with the selective ligation strategy demonstrated fewer abnormal outcomes than those treated with the early ligation approach (OR, 0.07; P = .046). Infants who underwent ligation before 10 days of age had an increased incidence of abnormal neurodevelopmental outcome. The significant difference in outcomes between the 2 PDA treatment strategies could be accounted for in part by the earlier age of ligation during period 1. A selective ligation approach for PDAs that fail to close with indomethacin therapy is not associated with worse neurodevelopmental outcomes at age 18-36 months.

The Need to Go Beyond: Evaluating Antenatal Corticosteroid Trials With Long-Term Outcomes

A single course of antenatal corticosteroids (ACS) reduces the risk of severe neonatal morbidity and is associated with a strong trend towards a reduced risk of abnormal neurodevelopmental outcome. However, because 50% of women given ACS remain undelivered and continue to be at risk for preterm delivery, the question remains: would these women benefit from repeated courses of ACS, and, if so, how do repeated courses of ACS affect the fetus and long-term neurodevelopmental outcome? The serious consequences of this effect on the developing brain justify the need for long-term outcome studies (beyond two years of age) before repeat courses of ACS become standard care in the management of pregnant women who are at risk of preterm delivery throughout pregnancy.

Early Brain Injury in Premature Newborns Detected with Magnetic Resonance Imaging is Associated with Adverse Early Neurodevelopmental Outcome

To determine the neurodevelopmental outcome of prematurely born newborns with magnetic resonance imaging (MRI) abnormalities. A total of 89 prematurely born newborns (median age 28 weeks postgestation) were studied with MRI when stable for transport to MRI (median age, 32 weeks postgestation); 50 newborns were studied again near term age (median age, 37 weeks). Neurodevelopmental outcome was determined at 18 months adjusted age (median) using the Mental Development Index (Bayley Scales Infant Development II) and a standardized neurologic exam. Of 86 neonatal survivors, outcome was normal in 51 (59%), borderline in 22 (26%), and abnormal in 13 (15%). Moderate/severe MRI abnormalities were common on the first (37%) and second (32%) scans. Abnormal outcome was associated with increasing severity of white matter injury, ventriculomegaly, and intraventricular hemorrhage on MRI, as well as moderate/severe abnormalities on the first (relative risk [RR] = 5.6; P = .002) and second MRI studies (RR = 5.3; P = .03). Neuromotor abnormalities on neurologic examination near term age (RR = 6.5; P = .04) and postnatal infection (RR = 4.0; P = .01) also increased the risk for abnormal neurodevelopmental outcome. In premature newborns, brain abnormalities are common on MRI early in life and are associated with adverse neurodevelopmental outcome.

Perinatal stroke in term infants with neonatal encephalopathy.

In a prospective cohort of 124 encephalopathic term infants, six infants had an acute focal stroke. All six encephalopathic patients with strokes presented with seizures. Neurodevelopmental outcome at 30 months was abnormal in all six patients and significantly worse when compared with the entire cohort overall. These findings suggest that in newborns with encephalopathy, acute focal strokes are an uncommon but serious occurrence with substantial risk for abnormal neurodevelopmental outcome.

Duration of rhythmic EEG patterns in neonates: new evidence for clinical and prognostic significance of brief rhythmic discharges

Objective: This study aimed at identifying the characteristics – especially the duration – of rhythmic discharges in neonatal EEG, and their association with clinical neonatal problems. Specifically, we aimed at testing the diagnostic and prognostic validity of using 10 s as minimal duration for defining electroencephalographic seizures. Design and methods: The polysomnographies of 340 neonates were reviewed, and episodes of rhythmic discharges were identified, analyzed, and quantified. The study sample was divided into 3 groups: one in which the maximal duration of rhythmic discharges was shorter than 10 s (brief rhythmic discharges, BRD), a second one in which there were rhythmic discharges longer than 10 s (long rhythmic discharges, LRD), and finally a group in which no rhythmic discharge was found (No-RD). These 3 groups of subjects were compared for the baseline and outcome clinical data. Results: From the 340 neonates studied, 210 did not present any form of rhythmic discharge, 67 (19.7%) had only BRD episodes, and 63 (18.5%) had at least one LRD episode. Prevalence of rhythmic discharges was low among healthy full term newborns, and was significantly higher among preterm and high-risk newborns. Electrophysiological characteristics of rhythmic discharges did not differ between healthy neonates and high-risk ones. Accompanying clinical manifestations were present in 26.3% of the LRD group, but also in 15.9% of the BRD group. The presence of BRD was significantly associated with leukomalacia and with hypoglycemia in the cross-sectional analysis of baseline data, and with an increased risk for abnormal neurodevelopmental outcome after a mean follow-up period of 47 months (adjusted relative risk=4.90, P<0.01). Conclusions: The present data demonstrate an association between BRD and clinical history of hypoxic-ischemic encephalopathy, especially when complicated by leukomalacia, and also with a prognosis of increased risk for abnormal neurodevelopmental outcome. The clinical and prognostic significance of isolated BRD justifies the need to include these brief episodes in future studies of neonatal seizures.

Identifying at risk infants following neonatal extracorporeal membrane oxygenation.

To identify infants at risk of death and abnormal neurodevelopmental outcome following extracorporeal membrane oxygenation (ECMO) in the neonatal period. The medical records of 82 neonates treated with ECMO were reviewed to evaluate risk of death. All survivors were followed by neurologic examinations and tested using the Bayley Scales of Infant Development or McCarthy Scale of Children's Abilities, and risk for abnormal neurodevelopmental outcome was assessed. The overall survival was 91% (75 of 82). The mean gestational age and birth weight of nonsurvivors were lower than those of survivors (37 +/- 1 weeks vs 40 +/- 0 weeks; 2734 +/- 230 vs 3325 +/- 69 gm, p < 0.05). Infants who were lost to follow-up (16%) did not differ from those with follow-up in demographic variables or clinical indicators of illness severity. Thirty-five of 63 infants (56%) with follow-up had normal neurodevelopmental outcome. Risk of abnormal outcome was higher in infants requiring assisted ventilation for > or = 15 days (relative risk [RR] 5.5; 95% confidence interval [CI] 2.0 to 14.8), supplemental oxygenation for > or = 22 days (RR 3.1; 95% CI 1.3 to 7.6), and black race (RR 8.9; 95% CI 1.3 to 62.9). None of the neuroimaging studies accurately predicted the neurodevelopmental outcome of these infants. We conclude that ECMO in critically ill infants is associated with good survival. The need for prolonged respiratory support may help in identifying infants at risk for abnormal neurodevelopmental outcome.

Incidence and neurodevelopmental outcome of periventricular hemorrhage and hydrocephalus in a regional population of very low birth weight infants

During the years 1984 to 1987, 459 very low birth weight (VLBW) infants were admitted to a state-designated Level III Neonatal Intensive Care Unit. Cerebral sonography performed in a standardized sequence and graded with the Papile scale diagnosed 97 (21.1%) children with periventricular hemorrhage (PVH). The incidence of PVH declined from a peak of 26.6% in 1985 to 16.4% in 1987, associated with an increase in the incidence of inborn admissions (including maternal transport) from 62.0% in 1984 to 80.4% in 1987. During initial hospitalization, the occurrence of both low-grade (Grades I and II) and high-grade PVH was associated with a significantly higher incidence of perinatal risk factors compared with a concurrent population of VLBW infants without PVH. Developmental follow-up was achieved in 93.3% of VLBW infants without PVH and 95.7% of VLBW infants with PVH who survived their initial hospitalization. The incidence of abnormal outcome ranged from 7 of 37 infants with Grade I PVH to 7 of 8 VLBW infants with Grade IV PVH. Only 1 of 16 VLBW infants with high-grade PVH demonstrated normal motor and cognitive development. Active hydrocephalus developed in 12 infants; 11 sustained a high-grade PVH. Appropriate treatment of intracranial hypertension did not modify the neurodevelopmental outcome. In conclusion, this regional population of VLBW infants demonstrated a decline in the incidence of PVH during the years 1984 to 1987 associated with an increase in the incidence of inborn admissions. The risk of abnormal neurodevelopmental outcome was elevated for all grades of PVH. A 12.0% incidence of hydrocephalus was associated with high-grade PVH, and appropriate treatment did not alter the poor prognosis.

Incidence and Neurodevelopmental Outcome of Periventricular Hemorrhage and Hydrocephalus in a Regional Population of Very Low Birth Weight Infants

Abstract During the years 1984 to 1987, 459 very low birth weight (VLBW) infants were admitted to a state-designated Level III Neonatal Intensive Care Unit. Cerebral sonography performed in a standardized sequence and graded with the Papile scale diagnosed 97 (21.1%) children with periventricular hemorrhage (PVH). The incidence of PVH declined from a peak of 26.6% in 1985 to 16.4% in 1987, associated with an increase in the incidence of inborn admissions (including maternal transport) from 62.0% in 1984 to 80.4% in 1987. During initial hospitalization, the occurrence of both low-grade (Grades I and II) and high-grade PVH was associated with a significantly higher incidence of perinatal risk factors compared with a concurrent population of VLBW infants without PVH. Developmental follow-up was achieved in 93.3% of VLBW infants without PVH and 95.7% of VLBW infants with PVH who survived their initial hospitalization. The incidence of abnormal outcome ranged from 7 of 37 infants with Grade I PVH to 7 of 8 VLBW infants with Grade IV PVH. Only 1 of 16 VLBW infants with high-grade PVH demonstrated normal motor and cognitive development. Active hydro-cephalus developed in 12 infants; 11 sustained a high-grade PVH. Appropriate treatment of intracranial hypertension did not modify the neurodevelopmental outcome. In conclusion, this regional population of VLBW infants demonstrated a decline in the incidence of PVH during the years 1984 to 1987 associated with an increase in the incidence of inborn admissions. The risk of abnormal neurodevelopmental outcome was elevated for all grades of PVH. A 12.0% incidence of hydrocephalus was associated with high-grade PVH, and appropriate treatment did not alter the poor prognosis.