Long term outcome after neonatal intraparenchymal echodensities with porencephaly

Rebecca L Sherlock ¹, Anne R Synnes ^1*, Ruth Eckstein Grunau ¹, Liisa Holsti ¹, Phillippa Hubber-Richard ¹, Debra Johannesen ¹ and Michael F. Whitfield ¹

¹ Children's and Women's Health Centre of British Columbia, Canada

^* To whom correspondence should be addressed. E-mail: asynnes{at}cw.bc.ca.

Accepted 8 August 2007

Abstract

Objective: To determine long term neurodevelopmental and functional outcomes of NICU survivors with neonatal intraparenchymal echodensities (IPE) with porencephaly on cranial ultrasonography as compared to matched controls. To describe the developmental trajectories of these infants over the childhood years as compared to matched controls.

Design: Cohort study.

Setting: Tertiary level Neonatal Intensive Care Unit (NICU) and the Neonatal Follow-Up Programme (NFUP) in Vancouver, Canada.

Patients: NICU survivors with birth weights < 1250 grams, born 1983-1985.

Methods: Cranial ultrasounds of NICU subjects with grade 4 intraventricular hemorrhage (IVH) were reviewed by a neuroradiologist and cases were defined, using stringent criteria, as IVH with intraparenchymal echodensity (IPE) with porencephaly. Controls with normal cranial ultrasounds, were selected case-matched for birthweight and sex. Prospective sequential multidisciplinary assessments were performed up to 17 years in the NFUP. Mann-Whitney U test was used to compare outcomes between cases and controls.

Results: Of 385 eligible patients, 14 met IPE and porencephaly criteria and 10 survived to discharge. All cases with IPE and porencephaly had one or more impairments, significantly different from preterm controls. At all ages assessed, rates of motor, cognitive and overall impairment were significantly higher in the cases. Most cases at adolescence were ambulatory, required learning assistance in school and had social challenges.

Conclusions: Children with neonatal IPE and porencephaly have a significantly worse long term neurodevelopmental outcome than children with normal cranial ultrasounds.

Keywords: IVH, neonatal follow-up, neonate, neurodevelopment

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