Outcomes of extremely preterm infants following severe intracranial hemorrhage

• Authors: Alexis S. Davis, Stanford University; Susan R. Hintz, Stanford University; Ricki F. Goldstein, Duke University; Namasivayam Ambalavanan, University of Alabama Birmingham; Carla M. Bann, RTI International; Barbara Stoll, Emory University; Edward F. Bell, University of Iowa; Seetha Shankaran, Wayne State University; Abbot R. Laptook, Brown University; Michele C. Walsh, Case Western Reserve University; Ellen C. Hale, Emory University; Nancy S. Newman, Case Western Reserve University; Abhik Das, RTI International; Rosemary D. Higgins, Eunice Kennedy Shriver National Institute of Child Health and Human Development
• Journal Title: Journal of Perinatology
• Volume: Volume 34, Number 3
• Publisher: Springer Nature [academic journals on nature.com]: Hybrid Journals | 2014-03-01, Pages 203-208
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1038/jp.2013.162
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Obstetrics & Gynecology; Pediatrics; intraventricular hemorrhage; neurodevelopmental impairment; extremely low birth weight; cranial ultrasound; BIRTH-WEIGHT INFANTS; GESTATIONAL-AGE; CEREBRAL-PALSY; NEURODEVELOPMENTAL OUTCOMES; INTRAVENTRICULAR HEMORRHAGE; NECROTIZING ENTEROCOLITIS; INTENSIVE-CARE; EPIPAGE COHORT; RISK-FACTORS; INFARCTION

Abstract

Objective:Severe intracranial hemorrhage (ICH) is an important prognostic variable in extremely preterm (EPT) infants. We examined imaging and clinical variables that predict outcomes in EPT infants with severe ICH. Study design:Retrospective analysis of 353 EPT infants with severe ICH. Outcomes were compared by examining: (i) unilateral vs bilateral ICH; and (ii) presence vs absence of hemorrhagic parenchymal infarction (HPI). Regression analyses identified variables associated with death or neurodevelopmental impairment (NDI). Result:Bilateral ICH and HPI had higher rates of adverse outcomes and were independently associated with death/NDI. HPI was the most important variable for infants of lower birth weight, and bilateral ICH for larger infants. For infants surviving to 36 weeks, shunt placement was most associated with death/NDI. Conclusion:Bilateral ICH and the presence of HPI in EPT infants with severe ICH are associated with death/NDI, though the importance depends on birth weight and survival to 36 weeks.