Neurodevelopmental outcome of periventricular haemorrhage and leukomalacia in infants 1250 g or less at birth

https://doi.org/10.1016/0378-3782(86)90164-7Get rights and content

Abstract

The brains of 50 consecutively admitted infants weighing 1250 g or less at birth were serially examined beyond the neonatal period for periventricular haemorrhage and for periventricular leukomalacia with real-time ultrasound. There was significant correlation between the presence or absence and the severity of haemorrhage with survival. A prospective neurodevelopmental assessment was completed at 2 years of age, corrected for prematurity, on all survivors. None of the 20 survivors with normal scans or germinal layer haemorrhages had evidence of major disability and all four survivors with intracerebral haemorrhage or periventricular leukomalacia had major disability. The mental performance on the Bayley scales of infant development was also significantly worse in the latter group. Six of the eight survivors with intraventricular haemorrhage had no major disability, including three who had post-haemorrhagic hydrocephalus. Our results showed that cerebral ultrasound detection of brain pathology is a good predictor of neurodevelopmental outcome in such extremely low birthweight infants. However, as the maximum extent of periventricular haemorrhage may develop beyond one week of age and cystic periventricular leukomalacia commonly develops after the neonatal period, serial scanning is mandatory to ensure diagnostic accuracy for both periventricular haemorrhage and leukomalacia.

References (33)

  • M.E. Bozynski et al.

    Longitudinal follow-up by ultrasound of intracranial hemorrhage and ventriculomegaly in relation to developmental outcome in infants weighing 1200 grams or less at birth, in Perinatal Intracranial Hemorrhage

  • A.G. Catto-Smith et al.

    Effect of neonatal periventricular haemorrhage on neurodevelopmental outcome

    Arch. Dis. Child.

    (1985)
  • R.W.I. Cooke

    Early prognosis of low birthweight infants treated for progressive posthaemorrhagic hydrocephalus

    Arch. Dis. Child.

    (1983)
  • L.S. Devries et al.

    Predictive value of cranial ultrasound in the newborn baby: a reappraisal

    Lancet

    (1985)
  • T. Dolfin et al.

    Incidence, severity, and timing of subependymal and intraventricular hemorrhages in preterm infants born in a perinatal unit as detected by serial real time ultrasound

    Pediatrics

    (1983)
  • L.M.S. Dubowitz et al.

    Developmental sequence of periventricular leukomalacia

    Arch. Dis. Child.

    (1985)
  • Cited by (37)

    • The Diagnosis, Management, and Postnatal Prevention of Intraventricular Hemorrhage in the Preterm Neonate

      2008, Clinics in Perinatology
      Citation Excerpt :

      Finally, mortality is higher in infants who have Gr 3–4 IVH than in gestational age–matched subjects who do not have Gr 3–4 IVH.12 Although prematurely born children who have Gr 3–4 IVH are at high risk for CP and mental retardation,2,13–20 children who have Gr 1–2 IVH also are at risk for developmental disability. One half to three quarters of infants who have Gr 3–4 IVH develop disabling CP in childhood, and in the large and well characterized cohort of Pinto-Martin and colleagues, Gr 3–4 IVH was associated with CP with an odds ratio (OR) of 15.4 (95% CI, 7.6–31.1).17

    • Preterm birth: A cost benefit analysis

      2004, Seminars in Perinatology
    • Adaptive mechanisms of developing brain: The neuroradiologic assessment of the preterm infant

      2000, Clinics in Perinatology
      Citation Excerpt :

      In summary, not all infants with abnormal cranial ultrasounds have CP and the ability of cranial ultrasonography best to predict outcome improves with advancing gestational age. In the two decades since Krishnamoorthy et al37 first reported that preterm infants with parenchymal involvement of hemorrhage experience major neurodevelopmental handicaps, many investigators have demonstrated that 45% to 85% of children with grade 4 IVH suffer mental retardation and CP at school age.23,37,48,74,77,83,84 Of perhaps even greater importance are recent data, which suggest that even children with low-grade hemorrhages are at cognitive disability when compared with their nonhemorrhage gestation age-matched peers.88

    View all citing articles on Scopus
    View full text