School performance in adolescents with and without periventricular-intraventricular hemorrhage in the neonatal period

doi:10.1053/j.semperi.2004.08.007

Seminars in Perinatology

Volume 28, Issue 4, August 2004, Pages 295-303

https://doi.org/10.1053/j.semperi.2004.08.007 Get rights and content

Abstract

Long-term sequelae of preterm birth have been studied extensively up until the age of 5 to 8 years. However, the cognitive development of adolescents born preterm has received limited attention. The objective of this study is to determine school performance in adolescents born very preterm. We have followed up a cohort of 484 infants born before 32 weeks of gestation in whom cranial ultrasound was routinely and systematically performed. School performance was assessed in the surviving adolescents at 14 years of age. The outcome variable divided the adolescents into three groups: (1) normal, (2) slow learners, and (3) special education. School performance data were obtained from 278 of 304 surviving adolescents; 129 performed normally, while 107 were slow learners, and 42 needed special education. From the unadjusted odds ratios for the need of special education by the various perinatal factors, only the odds ratio for periventricular-intraventricular hemorrhage was significantly associated (2.56, 95% confidence interval 1.17–4.86). Logistic regression analysis revealed that, after correction for possible confounding factors, the odds ratios for special education were significantly higher for adolescents with all grades of periventricular-intraventricular hemorrhage. Less than 50% of adolescents born before 32 weeks gestation perform normally in school. Periventricular-intraventricular hemorrhage, including the lower grades, does have an unfavorable additional effect on school performance.

Section snippets

Methods

During 1983, infants born in the Netherlands with a gestational age of less than 32 completed weeks and/or a birth weight below 1500 g participated in a prospective national survey on morbidity and mortality, which had a compliance rate of 94%.14 At that time, cranial ultrasound was routinely and systematically performed in 6 of the 8 neonatal intensive care units in the country. We studied prospectively the incidence of PIVH and subsequent neurodevelopmental outcome in a cohort of 484 infants

Results

School performance data at the age of 14 years were obtained from 278 (91.5%) of the 304 surviving adolescents. One hundred and twenty-nine (46.4%) adolescents performed normally in school; 107 (38.5%) appeared to be slow learners, whereas 42 (15.1%) participated in special education. The level of secondary education in relation to school performance is presented in Table 1. When compared with slow learners, adolescents with a normal school performance attended more frequently level A

Discussion

The compliance rate of our study was very high (91.5%). The overall school performance of our study cohort did not differ from the school performance of the remaining POPS cohort. School performance in our study cohort, however, was considerably poorer than in the general Dutch population (46.4% versus 80.6% normal performers, 38.5% versus 14.7% slow learners, and 15.1% versus 4.7% in special education) at 14 years of age.21 The worrisome finding that less than 50% of this very preterm born

Conclusion

We observed that less than 50% of adolescents born before 32 weeks gestation have a normal school performance. While PIVH, even the lower grades, was related to disability at the age of 5 years, we now demonstrate that PIVH also has an unfavorable additional effect on school performance.

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Decision-making for extremely preterm infants with severe hemorrhages on head ultrasound: Science, values, and communication skills
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Severe intracranial hemorrhages are not rare in extremely preterm infants. They occur early, generally when babies require life-sustaining interventions. This may lead to ethical discussions and decision-making about levels of care. Prognosis is variable and depends on the extent, location, and laterality of the lesions, and, importantly also on the subsequent occurrence of other clinical complications or progressive ventricular dilatation. Decision-making should depend on prognosis and parental values. This article will review prognosis and the uncertainty of outcomes for different lesions and provide an outline of ways to conduct an ethically appropriate discussion on the decision of whether to continue life sustaining therapy. It is possible to communicate in a compassionate and honest way with parents and engage in decision-making, focussing on personalized information and decisions, and on function, as opposed to diagnosis.
Neonatal Intraventricular Hemorrhage and Hospitalization in Childhood
2020, Pediatric Neurology
Citation Excerpt :
These children are at increased risk of cerebral palsy and neurosensory impairment, including seizures, language delay, and behavioral disorders, inevitably affecting activities of daily living and quality of life.1,5-7 They may need special educational support at school,8 which is associated with additional costs. Emerging research is showing that very low birth weight infants with neonatal comorbidities, including intraventricular hemorrhage, may have higher rates of orthopedic and ophthalmological hospitalizations,9 but data remain otherwise scarce.
Intraventricular hemorrhage is a serious neonatal complication associated with neurodevelopmental disorders, but the relationship with other childhood morbidities is unclear. We sought to assess the association of neonatal intraventricular hemorrhage with the risk of morbidity up to 12 years of age.
We analyzed a cohort of 794,384 infants born between 2006 and 2016 in Quebec, Canada, with 4,269,579 person-years of follow-up. The exposure was grade I to IV intraventricular hemorrhage in the neonatal period. The main outcome measure was childhood hospitalization by cause of admission. In adjusted Cox regression models, we estimated hazard ratios and 95% confidence intervals for the association of intraventricular hemorrhage with future childhood hospitalization.
Infants with intraventricular hemorrhage had a higher incidence of childhood hospitalization than infants without hemorrhage (23.8 vs. 5.7 per 100 person-years). Compared with those with no hemorrhage, infants with intraventricular hemorrhage had 1.56 times the risk of hospitalization (95% confidence interval, 1.43-1.70). The risk was 2.81 times higher for grade III/IV hemorrhage (95% confidence interval, 2.23-3.53). Intraventricular hemorrhage at term was associated with 3.19 times the risk of hospitalization (95% confidence interval, 2.55-4.00), whereas preterm intraventricular hemorrhage was associated with 2.06 times the risk before 28 weeks (95% confidence interval, 1.75-2.42) and 1.87 times the risk between 28 and 36 weeks (95% confidence interval, 1.68-2.08), compared with no hemorrhage at term. Primary reasons for hospitalizations included central nervous system, ophthalmologic, musculoskeletal, and cardiovascular disorders.
Intraventricular hemorrhage, especially of higher grades and in term neonates, is a predictor of future risk of hospitalization in childhood.
Early lumbar puncture and risk of intraventricular hemorrhage in very low birth weight infants
2018, Early Human Development
Citation Excerpt :
Cerebral blood flow autoregulation may be impaired in critically ill premature infants in the first days of life, and for infants requiring vasopressors, the autoregulation might be impaired even with low fluctuations of blood pressure [28]. IVH leads to short, medium and long-term sequelae, as seizures, intracranial hypertension, hydrocephalus, cerebral palsy, mental retardation and poor school performance [5–8,29]. The recommendation to perform a LP for infants with suspected early-onset sepsis is controversial.
Lumbar puncture (LP) is the gold standard for diagnosing meningitis; however it is unknown whether early LP (≤ 3 days of life) is associated with increased risk of intraventricular hemorrhage (IVH) in very low birth weight (VLBW) infants.
To determine whether early LP in VLBW infants is associated with severe IVH.
VLBW infants from a cohort of 1,158,789 infants discharged from 382 neonatal intensive care units (1997–2015) were enrolled. Exclusion criteria: infants with major congenital anomalies, outborns, died/transferred prior to day of life 3, and those who had an LP performed only after day of life 3. Logistic regression was used to determine the association between early LP and the incidence of severe IVH (IVH grades 3/4) by 28 days of life for each day of life from day 0 (birth) to day 3, adjusting for clinical covariates.
106,461 infants were included: 754 received an LP on Day-0, 640 on Day-1, 559 on Day-2 and 483 on Day-3. Severe IVH occurred in 4% (4130/104,025) of the infants in the no LP group and 9% (217/2436) of the LP group. Severe IVH was higher for infants with early LP: adjusted OR (95% confidence interval) = 2.64 (1.96–3.54) on Day-0; 2.21 (1.61–3.04) on Day-1; 1.55 (1.03–2.34) on Day-2; and 2.25 (1.50–3.38) on Day-3.
Early LP was associated with severe IVH in VLBW infants by 28 days of life. LP is either a surrogate for an unrecognized factor or is itself associated with an increased risk of IVH.
Childhood outcomes after low-grade intraventricular haemorrhage: A systematic review and meta-analysis
2024, Developmental Medicine and Child Neurology
Influence Factors and Prognostic Analysis of Peri-Intraventricular Hemorrhage in Premature Infants using Cranial Ultrasound
2023, Research Square
School-age outcomes of children after perinatal brain injury: A systematic review and meta-analysis
2023, BMJ Paediatrics Open

View all citing articles on Scopus

^☆: This study is part of the Project on Preterm and Small for gestational infants in the Netherlands (POPS).

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School performance in adolescents with and without periventricular-intraventricular hemorrhage in the neonatal period☆

Abstract

Section snippets

Methods

Results

Discussion

Conclusion

Am J Obstet Gynecol

Early Hum Dev

Clin Perinat

Lancet

Lancet

J Pediatr

Lancet

J Pediatr

Early Human Dev

Perinatal factors and periventricular-intraventricular hemorrhage in preterm infants

Am J Dis Child

Incidence and prediction of periventricular-intraventricular hemorrhage in very preterm infants

J Perinat Med

Intraventricular hemorrhage in preterm infantsDeclining incidence in 1980’s

Pediatrics

Intracranial hemorrhageGerminal matrix-intraventricular hemorrhage of the premature infant