Neurodevelopmental Outcome in Survivors of Periventricular Hemorrhagic Infarction

• Published in: Pediatrics (Evanston) 2007-10, Vol.120 (4), p.785-792
• Main Authors: Bassan, Haim, Limperopoulos, Catherine, Visconti, Karen, Mayer, D. Luisa, Feldman, Henry A, Avery, Lauren, Benson, Carol B, Stewart, Jane, Ringer, Steven A, Soul, Janet S, Volpe, Joseph J, du Plessis, Adre J
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Babies; Biological and medical sciences; Brain; Cerebral Hemorrhage - physiopathology; Cerebral Infarction - physiopathology; Cerebral Ventricles - physiopathology; Child, Preschool; Complications and side effects; Demographic aspects; Developmental delay; Diagnosis, Ultrasonic; Diagnostic ultrasonography; Evaluation; Female; Follow-Up Studies; General aspects; Hemorrhage; Humans; Infant; Infant, Newborn; Infant, Premature - physiology; Infant, Premature, Diseases - physiopathology; Infants (Premature); Interpersonal Relations; Intraventricular hemorrhage; Logistic Models; Male; Medical examination; Medical prognosis; Medical sciences; Methods; Neurologic Examination; Neurology; Outcome Assessment (Health Care); Patient outcomes; Pediatrics; Physiological aspects; Predictive Value of Tests; Premature birth; Premature infants; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Survivor; Survivors; Ultrasonic imaging; Vascular diseases and vascular malformations of the nervous system; Ventriculoperitoneal Shunt
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2007-0211

Periventricular hemorrhagic infarction is a serious complication of germinal matrix-intraventricular hemorrhage in premature infants. Our objective was to determine the neurodevelopmental and adaptive outcomes of periventricular hemorrhagic infarction survivors and identify early cranial ultrasound predictors of adverse outcome. We retrospectively evaluated all cranial ultrasounds of 30 premature infants with periventricular hemorrhagic infarction and assigned a cranial ultrasound-based periventricular hemorrhagic infarction severity score (range: 0-3) on the basis of whether periventricular hemorrhagic infarction (1) involved > or = 2 territories, (2) was bilateral, or (3) caused midline shift. We then performed neuromotor, visual function, and developmental evaluations (Mullen Scales of Early Learning, Vineland Adaptive Behavior Scale). Developmental scores below 2 SD from the mean were defined as abnormal. Median adjusted age at evaluation was 30 months (range: 12-66 months). Eighteen subjects (60%) had abnormal muscle tone, and 7 (26%) had visual field defects. Developmental delays involved gross motor (22 [73%]), fine motor (17 [59%]), visual receptive (13 [46%]), expressive language (11 [38%]), and cognitive (14 [50%]) domains. Impairment in daily living and socialization was documented in 10 (33%) and 6 (20%) infants, respectively. Higher cranial ultrasound-based periventricular hemorrhagic infarction severity scores predicted microcephaly and abnormalities in gross motor, visual receptive, and cognitive function. In the current era, two thirds of periventricular hemorrhagic infarction survivors develop significant cognitive and/or motor abnormalities, whereas adaptive skills are relatively spared. Higher cranial ultrasound-based periventricular hemorrhagic infarction severity scores predict worse outcome in several modalities and may prove to be a valuable tool for prognostication.