The Impact of Intraventricular Hemorrhage and Periventricular Leukomalacia on Mortality and Neurodevelopmental Outcome in Very Preterm and Very Low Birthweight Infants: A Prospective Population-based Cohort Study

• Published in: The Journal of pediatrics Vol. 262; p. 113600
• Main Authors: Pascal, Aurelie, de Bruyn, Nele, Naulaers, Gunnar, Ortibus, Els, Hanssen, Britta, Oostra, Ann, de Coen, Kris, Sonnaert, Michel, Cloet, Eva, Casaer, Alexandra, D’Haese, James, Laroche, Sabine, Jonckheere, An, Plaskie, Katleen, van Mol, Christine, Bruneel, Els, van Hoestenberghe, Marie-Rose, Samijn, Bieke, Govaert, Paul, Van den Broeck, Christine
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2023
• Subjects: Brain injury; Cerebral Hemorrhage; Cerebral palsy; Developmental disabilities; Neonatal intensive care unit; Neurodevelopmental impairment; developmental disabilities; brain injury; NDI; PVHI; neurodevelopmental impairment; neonatal intensive care unit; PVL; cerebral palsy; NICU; cerebral hemorrhage; IVH; CP; Cerebral palsy; Bayley-III-NL; GMH; OR; VLBW; Cerebral Hemorrhage; CI; Neurodevelopmental impairment; EPIBEL; Neonatal intensive care unit; BW; GA; VPT; Brain injury; Developmental disabilities; CA
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2023.113600

To survey the incidence of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) by gestational age and to report the impact on mortality and neurodevelopmental outcome in very preterm/very low birthweight infants. This was a population-based cohort study of 1927 very preterm/very low birthweight infants born in 2014-2016 and admitted to Flemish neonatal intensive care units. Infants underwent standard follow-up assessment until 2 years corrected age with the Bayley Scales of Infant and Toddler Development and neurological assessments. No brain lesion was present in 31% of infants born at <26 weeks of gestation and 75.8% in infants born at 29-32 weeks of gestation. The prevalence of low-grade IVH/PVL (grades I and II) was 16.8% and 12.7%, respectively. Low-grade IVH/PVL was not related significantly to an increased likelihood of mortality, motor delay, or cognitive delay, except for PVL grade II, which was associated with a 4-fold increase in developing cerebral palsy (OR, 4.1; 95% CI, 1.2-14.6). High-grade lesions (III-IV) were present in 22.0% of the infants born at <26 weeks of gestational and 3.1% at 29-32 weeks of gestation, and the odds of death were ≥14.0 (IVH: OR, 14.0; 95% CI, 9.0-21.9; PVL: OR, 14.1; 95% CI, 6.6-29.9). PVL grades III-IV showed an increased odds of 17.2 for motor delay and 12.3 for cerebral palsy, but were not found to be associated significantly with cognitive delay (OR, 2.9; 95% CI, 0.5-17.5; P = .24). Both the prevalence and severity of IVH/PVL decreased significantly with advancing gestational age. More than 75% of all infants with low grades of IVH/PVL showed normal motor and cognitive outcome at 2 years corrected age. High-grade PVL/IVH has become less common and is associated with adverse outcomes.