Early neurodevelopmental outcome of low birth weight infants surviving neonatal intraventricular hemorrhage

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Abstract
The follow-up findings are reported in 28 pre-term infants who survived symptomatic neonatal intraventricular hemorrhage and were cared for in the Neonatal Intensive Care Unit of Texas Children''s Hospital, Houston [USA]. The severity of hemorrhage noted on CT [computed tomography] scan was graded. The mean gestational age for the group was 28.9 wk (range 25-35 wk) and mean birth weight was 1179 g (range 700-1930). Seventeen infants were male and 11 were female. Paternal social class (Hollingshead''s classification) was distributed as follows: 27% class II, 31% class III and 42% class IV. Follow-up consisted of neurologic examination and multidisciplinary development assessment. The outcome categorizations (normal, suspect, abnormal) were based on both neurologic and developmental functioning. A child considered normal had a normal neurologic examination and developmental function within the normal range for corrected age. The term multihandicapped indicated both significant developmental delay and abnormal neurologic findings. At a mean age of 19.7 mo., 5 infants were considered normal (18%), 8 suspect (28%) and 15 abnormal (54%). Eight abnormal infants were multihandicapped. Cerebral palsy was noted in 9 infants (32%). Post-hemorrhagic hydrocephalus was noted in 8; 7 required shunting. Three infants with shunts later demonstrated microcephaly. Three developed infantile spasms. Neurosensory deficits included blindness (secondary to cicatricial retinopathy of prematurity) in 4 infants and hearing loss in 2. At least 1/3 of the study group will require special education by age 3 yr. Two significant findings emerged in this study: the incidence of abnormal outcome was higher among infants with grades III and IV hemorrhage (79%) than among infants with grades I or II hemorrhage (29%) (0.01 < P < 0.025); and the mean gestational age of the 8 multihandicapped infants (27.0 wk) was significantly below that of the remaining 20 infants (29.7 wk) (0.001 < P < 0.01). Although 46% of the study group did not have static abnormalities when evaluated, they remain at risk for disorders of language, learning and behavior. Long-term follow-up of these infants is planned to determine if these disorders may, in part, be related to the occurrence or secondary effects of earlier intraventricular hemorrhage.