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. 2023 Nov:262:113600.
doi: 10.1016/j.jpeds.2023.113600. Epub 2023 Jul 2.

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

Aurelie Pascal  1 , Nele de Bruyn  2 , Gunnar Naulaers  3 , Els Ortibus  4 , Britta Hanssen  5 , Ann Oostra  6 , Kris de Coen  7 , Michel Sonnaert  8 , Eva Cloet  9 , Alexandra Casaer  10 , James D'Haese  11 , Sabine Laroche  12 , An Jonckheere  13 , Katleen Plaskie  14 , Christine van Mol  14 , Els Bruneel  15 , Marie-Rose van Hoestenberghe  15 , Bieke Samijn  2 , Paul Govaert  2 , Christine Van den Broeck  2
Affiliations

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

Aurelie Pascal et al. J Pediatr. 2023 Nov.

Abstract

Objective: 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.

Study design: 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.

Results: 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).

Conclusions: 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.

Keywords: brain injury; cerebral hemorrhage; cerebral palsy; developmental disabilities; neonatal intensive care unit; neurodevelopmental impairment.

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Conflict of interest statement

Declaration of Competing Interest The follow-up study is funded by the Belgian Ministry of Health. Nonetheless, this investigation did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Therefore, there were no sponsors involved in any parts of this investigation The authors have no potential conflicts of interest to disclose.

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