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. 2013 Jan;33(1):25-32.
doi: 10.1038/jp.2012.91. Epub 2012 Jul 19.

Influence of gestational age on death and neurodevelopmental outcome in premature infants with severe intracranial hemorrhage

R F Goldstein  1 , C M Cotten, S Shankaran, M G Gantz, W K Poole; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations

Influence of gestational age on death and neurodevelopmental outcome in premature infants with severe intracranial hemorrhage

R F Goldstein et al. J Perinatol. 2013 Jan.

Abstract

Objective: To determine whether death and/or neurodevelopmental impairment (NDI) after severe intracranial hemorrhage (ICH; grade 3 or 4) differs by gestational age (GA) at birth in extremely low birth weight (ELBW) infants.

Study design: Demographic, perinatal and neonatal factors potentially contributing to NDI for ELBW infants (23 to 28 weeks gestation) were obtained retrospectively; outcome data came from the ELBW Follow-up Study. NDI was defined at 18 to 22 months corrected age as moderate/severe cerebral palsy, Bayley Scales of Infant Development II cognitive or motor score <70, and/or blindness or deafness. Characteristics of younger versus older infants with no versus severe ICH associated with death or NDI were compared. Generalized linear mixed models predicted death or NDI in each GA cohort.

Result: Of the 6638 infants, 61.8% had no ICH and 13.6% had severe ICH; 39% of survivors had NDI. Risk-adjusted odds of death or NDI and death were higher in the lower GA group. Lower GA increased the odds of death before 30 days for infants with severe ICH. Necrotizing enterocolitis (particularly surgical NEC), late onset infection, cystic periventricular leukomalacia and post-natal steroids contributed to mortality risk. NDI differed by GA in infants without ICH and grade 3, but not grade 4 ICH. Contributors to NDI in infants with severe ICH included male gender, surgical NEC and post-hemorrhagic hydrocephalus requiring a shunt.

Conclusion: GA contributes to the risk of death in ELBW infants, but not NDI among survivors with severe ICH. Male gender, surgical NEC and need for a shunt add additional risk for NDI.

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Conflict of interest statement

Conflict of interest

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Percentage of infants with primary outcome, death or neurodevelopmental impairment (NDI), and its components by gestational age (GA) at birth and intracranial hemorrhage (ICH) grade. Values are from bivariate analyses. *P<0.05. Note: NDI (% of survivors), death and death/NDI (% of all infants).
Figure 2
Figure 2
Death (before and after 30 days) and neurodevelopmental impairment (NDI) by gestational age (GA) at birth and intracranial hemorrhage (ICH) grade among infants with known outcomes
Figure 3
Figure 3
Factors predicting neurodevelopmental impairment (NDI) in infants with grade 4 intracranial hemorrhage (ICH)
See this image and copyright information in PMC

Comment in

References

    1. Bassan H, Limperopoulos C, Visconti K, Mayer DL, Feldman HA, Avery L, et al. Neurodevelopmental outcome in survivors of periventricular hemorrhagic infarction. Pediatrics. 2007;120(4):785–792. - PubMed
    1. de Vries LS, Rademaker KJ, Groenendaal F, Eken P, van Haastert IC, Vandertop WP, et al. Correlation between neonatal cranial ultrasound, MRI in infancy and neurodevelopmental outcome in infants with a large intraventricular haemorrhage with or without unilateral parenchymal involvement. Neuropediatrics. 1998;29(4):180–188. - PubMed
    1. Hack M, Taylor HG. Perinatal brain injury in preterm infants and later neurobehavioral function. JAMA. 2000;284(15):1973–1974. - PubMed
    1. Maitre NL, Marshall DD, Price WA, Slaughter JC, O’Shea TM, Maxfield C, et al. Neurodevelopmental outcome of infants with unilateral or bilateral periventricular hemorrhagic infarction. Pediatrics. 2009;124(6):e1153–e1160. - PMC - PubMed
    1. O’Shea TM, Kuban KC, Allred EN, Paneth N, Pagano M, Dammann O, et al. Neonatal cranial ultrasound lesions and developmental delays at 2 years of age among extremely low gestational age children. Pediatrics. 2008;122(3):e662–e669. - PMC - PubMed

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