title: Periventricular/Intraventricular Hemorrhage and Neurodevelopmental Outcomes: A Meta-analysis.
abstract: BACKGROUND
  Periventricular/intraventricular hemorrhage (PIVH) is a common short-term morbidity in preterm infants, but its long-term neurodevelopmental impact, particularly with mild PIVH, remains unclear.
  
  
  OBJECTIVE
  To systematically review and meta-analyze the neurodevelopmental outcomes of preterm infants ≤34 weeks' gestation with mild and severe PIVH, compared with no PIVH.
  
  
  METHODS
  Medline, Embase, CINAHL, and PsychINFO databases from January 2000 through June 2014.
  
  
  METHODS
  Studies reporting long-term neurodevelopmental outcomes based on severity of PIVH were included.
  
  
  METHODS
  Study characteristics, inclusion/exclusion criteria, exposures, and outcome assessment data extracted independently by 2 coauthors.
  
  
  RESULTS
  The pooled unadjusted odds ratios of the primary outcome of death or moderate-severe neurodevelopmental impairment (NDI) were higher with both mild (1.48, 95% CI 1.26-1.73; 2 studies) and severe PIVH (4.72, 4.21-5.31; 3 studies); no studies reported adjusted odds ratios. Among survivors, odds of moderate-severe NDI were higher with mild and severe PIVH in both unadjusted (1.75, 1.40-2.20; 3 studies; 3.36, 3.06-3.68; 5 studies) and adjusted (1.39, 1.09-1.77; 3 studies; 2.44, 1.73-3.42; 2 studies) pooled analyses. Adjusted odds of cerebral palsy and cognitive delay were higher with severe but not mild PIVH.
  
  
  CONCLUSIONS
  Only observational studies were included. Fifteen of 21 included studies had a moderate-high risk of bias.
  
  
  CONCLUSIONS
  Mild and severe PIVH are associated with progressively higher odds of death or moderate-severe NDI compared with no PIVH, but no studies adjusted for confounders. Among survivors, mild PIVH was associated with higher odds of moderate-severe NDI compared with no PIVH.
authors.affiliation: Department of Paediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Canada; and mukerji@mcmaster.ca.
authors.forename: Amit
authors.initials: A
authors.lastname: Mukerji
authors.affiliation: Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
authors.forename: Vibhuti
authors.initials: V
authors.lastname: Shah
authors.affiliation: Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications* / Q000401:mortality; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D002658:Developmental Disabilities / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases; D018570:Risk Assessment