title: Severe intraventricular hemorrhage and withdrawal of support in preterm infants.
abstract: The objective of the study was to determine whether withdrawal of support in severe 'intraventricular hemorrhage' (IVH), that is, IVH grade 3 and periventricular hemorrhagic infarction (PVHI), has decreased after publication of studies that show improved prognosis and to examine cranial ultrasonograms, including PVHI territories defined by Bassan.
  
  
  
  Retrospective cohort of preterm infants from 23 0/7 to 28 6/7 weeks' gestation in 1993 to 2013.
  
  
  
  Among the 1755 infants, 1494 had no bleed, germinal matrix hemorrhage (GMH) or IVH grade 2, 137 had grade 3 IVH and 124 had PVHI. The odds of withdrawal of support, adjusted for severity of GMH-IVH and baseline variables, did not decrease after publications showing better prognosis. Among 82 patients who died with PVHI, 76 had life support withdrawn, including 34 without another contributing cause of death. The median number of PVHI territories involved was three.
  
  
  
  Withdrawal of support adjusted for severity of GMH-IVH did not significantly change after publications showing better prognosis.
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Sheehan
authors.affiliation: Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Pritchard
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Heyne
authors.affiliation: Parkland Health and Hospital System, Dallas, TX, USA.
authors.forename: L S
authors.initials: LS
authors.lastname: Brown
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Jaleel
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: W D
authors.initials: WD
authors.lastname: Engle
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Burchfield
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: L P
authors.initials: LP
authors.lastname: Brion
mesh_terms: D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D016208:Databases, Factual; D004453:Echoencephalography; D005260:Female; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008020:Life Support Care; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013781:Texas / Q000453:epidemiology; D028761:Withholding Treatment / Q000706:statistics & numerical data*