Influence of gestational age on death and neurodevelopmental outcome in premature infants with severe intracranial hemorrhage

• Published in: Journal of perinatology Vol. 33; no. 1; pp. 25 - 32
• Main Authors: Goldstein, R F, Cotten, C M, Shankaran, S, Gantz, M G, Poole, W K
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.01.2013; Nature Publishing Group
• Subjects: 692/699/375/1370; 692/699/375/366; 692/700/1720; Birth weight; Birth weight, Low; Blindness - diagnosis; Blindness - mortality; Brain; Brain Damage, Chronic - diagnosis; Brain Damage, Chronic - mortality; Cause of Death; Cerebral palsy; Cerebral Palsy - diagnosis; Cerebral Palsy - mortality; Cohort Studies; Deafness - diagnosis; Deafness - mortality; Demographic aspects; Developmental Disabilities - diagnosis; Developmental Disabilities - mortality; Diagnosis; Female; Gestational Age; Health aspects; Hemorrhage; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases - diagnosis; Infant, Premature, Diseases - mortality; Infants (Premature); Intellectual Disability - diagnosis; Intellectual Disability - mortality; Intracranial Hemorrhages - diagnosis; Intracranial Hemorrhages - mortality; Linear Models; Male; Medical prognosis; Medicine; Medicine & Public Health; Neonatal care; Nervous system diseases; original-article; Pediatric Surgery; Pediatrics; Premature babies; Premature birth; Psychomotor Disorders - diagnosis; Psychomotor Disorders - mortality; Retrospective Studies; Survival Rate; United States; United States; United States > US; premature; neurodevelopmental impairment; extremely low birth weight; death; infant
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2012.91

Objective: To determine whether death and/or neurodevelopmental impairment (NDI) after severe intracranial hemorrhage (ICH; grade 3 or 4) differs by gestational age (GA) at birth in extremely low birth weight (ELBW) infants. Study Design: Demographic, perinatal and neonatal factors potentially contributing to NDI for ELBW infants (23 to 28 weeks gestation) were obtained retrospectively; outcome data came from the ELBW Follow-up Study. NDI was defined at 18 to 22 months corrected age as moderate/severe cerebral palsy, Bayley Scales of Infant Development II cognitive or motor score <70, and/or blindness or deafness. Characteristics of younger versus older infants with no versus severe ICH associated with death or NDI were compared. Generalized linear mixed models predicted death or NDI in each GA cohort. Result: Of the 6638 infants, 61.8% had no ICH and 13.6% had severe ICH; 39% of survivors had NDI. Risk-adjusted odds of death or NDI and death were higher in the lower GA group. Lower GA increased the odds of death before 30 days for infants with severe ICH. Necrotizing enterocolitis (particularly surgical NEC), late onset infection, cystic periventricular leukomalacia and post-natal steroids contributed to mortality risk. NDI differed by GA in infants without ICH and grade 3, but not grade 4 ICH. Contributors to NDI in infants with severe ICH included male gender, surgical NEC and post-hemorrhagic hydrocephalus requiring a shunt. Conclusion: GA contributes to the risk of death in ELBW infants, but not NDI among survivors with severe ICH. Male gender, surgical NEC and need for a shunt add additional risk for NDI.