Effects of intraventricular hemorrhage and socioeconomic status on perceptual, cognitive, and neurologic status of low birth weight infants at 5 years of age

doi:10.1016/S0022-3476(05)81204-1

The Journal of Pediatrics

Volume 121, Issue 2, August 1992, Pages 280-285

https://doi.org/10.1016/S0022-3476(05)81204-1 Get rights and content

A prospective longitudinal study assessed the effects of intraventricular hemorhage (IVH) and socioeconomic status on the perceptual, cognitive, and neurologic status of preterm infants at 5 years of age. The preterm group consisted of infants with no IVH, grade I to II IVH, and grade III to IV IVH; a control group of normal term infants was also studied. Outcome was evaluated at 3, 4 and 5 years of age. Twenty-four percent of infants with grade III to IV IVH had abnormal neurologic diagnoses at 5 years of age. Correlations of predictor variables including IVH status, latency of visual evoked response, days of hospitalization, and socioeconomic status with 5-year neurologic outcome indicated that IVH status and visual evoked response at 1, 2, and 3 years continued to have an effect on neurologic outcome, but socioeconomic status and days of hospitalization did not; socioeconomic status did have a significant effect on the McCarthy cognitive scores but not on the perceptual scores at 5 years. Multiple regression analyses revealed that duration of hospitalization (reflecting neonatal morbidity), visual evoked response, and socioeconomic status all have independent effects on the cognitive index, whereas only duration of hospitalization has an independent effect on the perceptual index. These data support the concept that a complex interaction of biologic and environmental risk factors determines the degree of recovery from IVH by high-risk preterm infants.

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Cited by (101)

Impact of low-grade intraventricular hemorrhage on neurodevelopmental outcome in very preterm infants at two years of age
2023, Early Human Development
High-grade intraventricular hemorrhage (IVH) in very preterm infants is a known risk factor for adverse neurodevelopmental outcome. Prognosis is less clear for low-grade (grades I/II) IVH however, with conflicting study results in recent years.
To evaluate the impact of low-grade IVH on neurodevelopmental outcome at 2 years corrected age in preterm infants born below 32 weeks gestation at the University hospital of Zurich between 2009 and 2014.
Among 843 live-born preterm infants born during the observation period, 509 were included in our study. Exclusion criteria were death, high-grade IVH, cystic periventricular leukomalacia and congenital malformations. Infants were grouped into those with or without low-grade IVH according to cranial ultrasound. Neurodevelopmental impairment (NDI) was defined as cognitive or motor developmental score > 2 standard deviations below the mean and/or CP grades 2–5 and/or moderate/severe vision loss and/or hearing problem corrected with hearing aids. Multivariate linear regression was used to assess effect of low-grade IVH on endpoints while adjusting for other risk factors.
87 preterm infants had low-grade IVH (42 grade I, 45 grade II) on cranial ultrasound. These were compared to 422 preterm infants without IVH. Follow-up rate was 82.4 %. Preterm infants with low-grade IVH had higher rates of NDI (21.8 vs 13.3 %, p = 0.047). Infants with IVH grade II had significantly higher rates for CP (8.9 % vs 3.6 %, p = 0.003), visual impairment (20.5 % vs 8.3 %, p = 0.009) and NDI (33.3 % vs 13.3 %, p < 0.001).
In our study, low-grade IVH – and especially IVH grade II - is associated with adverse neurodevelopmental outcome at 2 years of corrected age.
Advances in Management for Preterm Fetuses at Risk of Delivery
2020, Clinics in Perinatology
Citation Excerpt :
In the 1980s, very-low-birthweight (VLBW) infants (<1500 g) made up less than 1% of survivors but contributed to 28% of children with disabling cerebral palsy.16 The high cerebral palsy rate in VLBW infants has been linked to the increased incidence of germinal matrix and intraventricular hemorrhage in this population.17 Interestingly, multiple prospective trials discovered a decreased neonatal cerebral hemorrhage risk in patients both with preeclampsia and with preterm labor.18–20
Preterm brain injury: Germinal matrix–intraventricular hemorrhage and post-hemorrhagic ventricular dilatation
2019, Handbook of Clinical Neurology
Germinal matrix hemorrhage and intraventricular hemorrhages (GMH-IVH) remain a common and clinically significant problem in preterm infants, particularly extremely preterm infants. A large GMH-IVH is often complicated by posthemorrhagic ventricular dilation (PHVD) or parenchymal hemorrhagic infarction and is associated with an increased risk of adverse neurologic sequelae.
The widespread use of cranial ultrasonography since the early 1980s has shown a gradual decrease in the incidence of GMH-IVH and has helped with the identification of antenatal and perinatal risk factors and timing of the lesion. The increased use of magnetic resonance imaging (MRI) has contributed to more detailed visualization of the site and extent of the GMH-IVH. In addition, MRI has contributed to the awareness of associated white matter changes as well as associated cerebellar hemorrhages. Although GMH-IVH and PHVD still cannot be prevented, cerebrospinal fluid drainage initiated in the early stage of PHVD development seems to be associated with a better neurodevelopmental outcome. Further studies are underway to improve treatment strategies for PHVD and to potentially prevent and repair GMH-IVH and PHVD and associated brain injury.
This chapter discusses the pathogenesis, incidence, risk factors, and management, including preventive measures, of GHM-IVH and PHVD.
Preterm Intraventricular Hemorrhage/Posthemorrhagic Hydrocephalus
2018, Volpe's Neurology of the Newborn
Germinal matrix hemorrhage–intraventricular hemorrhage (GMH-IVH) is the most common variety of neonatal intracranial hemorrhage and is characteristic of the premature infant. This form of brain injury affects around 25% of all very low birthweight (<1500 g) premature infants, resulting in an increased risk for neurodevelopmental disability. Its occurrence can lead to impact on subsequent brain development because of destruction of the immature germinal cerebral region resulting in loss of progenitor cells, acceleration of white matter injury via pressure and oxidative stress, and direct parenchymal injury. Finally, hydrocephalus can complicate IVH, resulting in a further increased risk of neurodevelopmental disability. In this chapter, the neuropathology, pathogenesis, clinical features, diagnosis, prognosis, and management of IVH, and its complications will be reviewed. The prominent position of this lesion in neonatal medicine has been accompanied by a large increase in work from several disciplines. This chapter attempts to integrate this information in a meaningful way without oversimplifying a clearly complex problem.
Neurobehavioral development of preterm and full term children: Biomedical and environmental influences
2013, Early Human Development
Citation Excerpt :
Low maternal education was related to lower developmental outcomes after 2 years of age in VLBW children [18] as well as in FT children [19,20]. Similar effects were found for SES (socio economic status) and racial minority status [19–21]. Other studies found that a combination of multiple biological and environmental factors (such as SES or home quality) may predict later linguistic and cognitive abilities [22,23].
Previous studies indicate that VLBW preterm children obtain significantly lower scores than full-term children in all the NBAS clusters. However the samples studied usually presented additional medical complications.
The present study aims to compare the results obtained by low-risk preterm and full term children in the NBAS, and relate possible differences to biological and contextual factors.
Early neurobehavioral development of 150 preterm (PR) children is compared to that of 49 full term children (FT). The children were assessed at the age of 15 days (corrected age for preterm children) with the NBAS. Biological and environmental variables were collected through an extended interview with the mothers as well as medical data.
Significant differences were found between preterm and full term children in the following areas: motor, range of state, and regulation of state. Differences were also found in relation to birth weight in these same three areas, following a parallel pattern. These differences between the two groups were not, however, necessarily more favorable for the FT group; the PR group had higher results in the motor and range of state areas, and lower results in the regulation of state area. The mothers' smoking habit had a negative effect on infants' regulation and orientation.
No general maturation delay in this particular sample of preterm children was found.
The impact of ethnic population dynamics on neonatal ECMO outcomes: A single urban institutional study
2013, Journal of Surgical Research
Neonatal extracorporeal membrane oxygenation ECMO has been clinically used for the last 25 y. It has been an effective tool for both cardiac and non cardiac conditions. The impact of ethno-demographic changes on ECMO outcomes however remains unknown. We evaluated a single institution's experience with non cardiac neonatal ECMO over a 28-y period.
A retrospective review of all neonates undergoing noncardiac ECMO between the y 1984 and 2011 was conducted and stratified into year groups I, II, III (≤1990, 1991–2000, and ≥2001). Demographic, clinical, and outcome data were collected. The patient specifics, ECMO type, ECMO length, blood use, complications, and outcomes were analyzed. Univariate, bivariate, and multivariate analyses were then performed.
Data was available for 827 patients. The number of African-American and Hispanic patients increased over the last 27 y (27.5% versus 45.0% and 3.3% versus 21.5%, year group I versus year group III, respectively). The proportion of congenital diaphragmatic hernia (CDH) patients by ethnicity also increased for African-Americans and Hispanics between the two year groups (22.0% to 33.0% and 4.9% to 33.0%, respectively). Similar pattern was noted for non-CDH diagnoses. Low birth weight, low APGAR scores, CDH, primary pulmonary hypertension, central nervous system hemorrhage, and ECMO were independent predictors of mortality. Ethnicity, in itself however, was not associated with mortality on adjusted analysis.
More African-Americans and Hispanics have required ECMO over the years with a concurrent decrease in the number of Caucasians. While ethnicity was not an independent predictor of mortality, it appears to be a surrogate for fatal but sometime preventable diagnoses among minorities. Further investigations are needed to better delineate the reason behind this disparity.

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Effects of intraventricular hemorrhage and socioeconomic status on perceptual, cognitive, and neurologic status of low birth weight infants at 5 years of age

J Pediatr

Electroencephalogr Clin Neurophysiol

J Pediatr

J Pediatr

Four-Factor Index of Social Status

Visual evoked potentials in infants with hydrocephalus

Neurology

Neurodevelopmental and school performance of very low birth weight infants: a seven-year longitudinal study

Pediatrics

Preschool performance of children with normal intelligence who were very low birth weight infants

Pediatrics

Bayley Scales of Infant Development