title: Intraventricular hemorrhage and neurodevelopmental outcomes in extreme preterm infants.
abstract: OBJECTIVE
  Not many large studies have reported the true impact of lower-grade intraventricular hemorrhages in preterm infants. We studied the neurodevelopmental outcomes of extremely preterm infants in relation to the severity of intraventricular hemorrhage.
  
  
  METHODS
  A regional cohort study of infants born at 23 to 28 weeks' gestation and admitted to a NICU between 1998 and 2004. Primary outcome measure was moderate to severe neurosensory impairment at 2 to 3 years' corrected age defined as developmental delay (developmental quotient >2 SD below the mean), cerebral palsy, bilateral deafness, or bilateral blindness.
  
  
  RESULTS
  Of the 1472 survivors assessed, infants with grade III-IV intraventricular hemorrhage (IVH; n = 93) had higher rates of developmental delay (17.5%), cerebral palsy (30%), deafness (8.6%), and blindness (2.2%). Grade I-II IVH infants (n = 336) also had increased rates of neurosensory impairment (22% vs 12.1%), developmental delay (7.8% vs 3.4%), cerebral palsy (10.4% vs 6.5%), and deafness (6.0% vs 2.3%) compared with the no IVH group (n = 1043). After exclusion of 40 infants with late ultrasound findings (periventricular leukomalacia, porencephaly, ventricular enlargement), isolated grade I-II IVH (n = 296) had increased rates of moderate-severe neurosensory impairment (18.6% vs 12.1%). Isolated grade I-II IVH was also independently associated with a higher risk of neurosensory impairment (adjusted odds ratio 1.73, 95% confidence interval 1.22-2.46).
  
  
  CONCLUSIONS
  Grade I-II IVH, even with no documented white matter injury or other late ultrasound abnormalities, is associated with adverse neurodevelopmental outcomes in extremely preterm infants.
authors.affiliation: FRACP, Division of Newborn Services, Royal Hospital for Women, Barker Street, Locked Bag 2000, Randwick, 2031 NSW, Australia. Srinivas.Bolisetty@sesiahs.health.nsw.gov.au.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Bolisetty
authors.forename: Anjali
authors.initials: A
authors.lastname: Dhawan
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Latif
authors.forename: Barbara
authors.initials: B
authors.lastname: Bajuk
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Stack
authors.forename: Kei
authors.initials: K
authors.lastname: Lui
mesh_terms: D001766:Blindness / Q000453:epidemiology / Q000209:etiology*; D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology*; D002552:Cerebral Ventricles; D002675:Child, Preschool; D003638:Deafness / Q000453:epidemiology / Q000209:etiology*; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D014463:Ultrasonography
keywords: extremely premature; infant; intraventricular hemorrhage; neurodevelopmental outcomes