Neurodevelopmental outcome in survivors of periventricular hemorrhagic infarction.
OBJECTIVE
Periventricular hemorrhagic infarction is a serious complication of germinal matrix-intraventricular hemorrhage in premature infants. Our objective was to determine the neurodevelopmental and adaptive outcomes of periventricular hemorrhagic infarction survivors and identify early cranial ultrasound predictors of adverse outcome.


METHODS
We retrospectively evaluated all cranial ultrasounds of 30 premature infants with periventricular hemorrhagic infarction and assigned a cranial ultrasound-based periventricular hemorrhagic infarction severity score (range: 0-3) on the basis of whether periventricular hemorrhagic infarction (1) involved > or = 2 territories, (2) was bilateral, or (3) caused midline shift. We then performed neuromotor, visual function, and developmental evaluations (Mullen Scales of Early Learning, Vineland Adaptive Behavior Scale). Developmental scores below 2 SD from the mean were defined as abnormal.


RESULTS
Median adjusted age at evaluation was 30 months (range: 12-66 months). Eighteen subjects (60%) had abnormal muscle tone, and 7 (26%) had visual field defects. Developmental delays involved gross motor (22 [73%]), fine motor (17 [59%]), visual receptive (13 [46%]), expressive language (11 [38%]), and cognitive (14 [50%]) domains. Impairment in daily living and socialization was documented in 10 (33%) and 6 (20%) infants, respectively. Higher cranial ultrasound-based periventricular hemorrhagic infarction severity scores predicted microcephaly and abnormalities in gross motor, visual receptive, and cognitive function.


CONCLUSIONS
In the current era, two thirds of periventricular hemorrhagic infarction survivors develop significant cognitive and/or motor abnormalities, whereas adaptive skills are relatively spared. Higher cranial ultrasound-based periventricular hemorrhagic infarction severity scores predict worse outcome in several modalities and may prove to be a valuable tool for prognostication.
Bassan
Haim
H
Department of Neurology, Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
Limperopoulos
Catherine
C
Visconti
Karen
K
Mayer
D Luisa
DL
Feldman
Henry A
HA
Avery
Lauren
L
Benson
Carol B
CB
Stewart
Jane
J
Ringer
Steven A
SA
Soul
Janet S
JS
Volpe
Joseph J
JJ
du Plessis
Adré J
AJ
D000203:Activities of Daily Living; D002543:Cerebral Hemorrhage / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000503:physiopathology*; D002552:Cerebral Ventricles / Q000503:physiopathology*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007235:Infant, Premature, Diseases / Q000503:physiopathology*; D007398:Interpersonal Relations; D016015:Logistic Models; D008297:Male; D009460:Neurologic Examination; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017741:Survivors; D017287:Ventriculoperitoneal Shunt