Neurodevelopmental outcome of infants with unilateral or bilateral periventricular hemorrhagic infarction

Pediatrics. 2009 Dec;124(6):e1153-60. doi: 10.1542/peds.2009-0953.


Objective: Periventricular hemorrhagic infarction (PVHI) is a major contributing factor to poor neurodevelopmental outcomes in preterm infants. We hypothesized that surviving infants with unilateral PVHI would have more favorable outcomes than those with bilateral PVHI.

Methods: This was a multicenter, retrospective study of infants who were admitted to 3 NICUs in North Carolina from 1998 to 2004. The clinical course and late neuroimaging studies and neurodevelopmental outcomes of 69 infants who weighed <1500 g and had confirmed PVHI on early cranial ultrasonography were reviewed. A predictive model for Bayley Scales of Infant Development, Second Edition, Mental Developmental Index (MDI) <70 was constructed by using radiologic and clinical variables.

Results: Infants with unilateral PVHI had higher median MDI (82 vs 49) and Psychomotor Developmental Index (53 vs 49) than infants with bilateral PVHI. Infants with unilateral PVHI were less likely to have severe cerebral palsy (adjusted odds ratio: 0.15 [95% confidence interval (CI): 0.05-0.45]) than infants with bilateral PVHI. Infants who had unilateral PVHI and developed periventricular leukomalacia and retinopathy of prematurity that required surgery had an increased probability of having MDI <70 compared with those without these complications (probability of MDI <70: 89% [95% CI: 0.64-1.00] vs 11% [95% CI: 0.01-0.28]).

Conclusions: Infants with unilateral PVHI had better motor and cognitive outcomes than infants with bilateral PVHI. By combining laterality of PVHI, periventricular leukomalacia, and retinopathy of prematurity it is possible to estimate the probability of having an MDI <70, which will assist clinicians when counseling families.

MeSH terms

  • Brain Damage, Chronic / diagnosis*
  • Brain Damage, Chronic / mortality
  • Cerebral Hemorrhage / diagnosis*
  • Cerebral Infarction / diagnosis*
  • Cerebral Infarction / mortality
  • Cerebral Ventricles / blood supply*
  • Child, Preschool
  • Cohort Studies
  • Developmental Disabilities / diagnosis*
  • Developmental Disabilities / mortality
  • Dominance, Cerebral / physiology
  • Echoencephalography
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature, Diseases / diagnosis*
  • Leukomalacia, Periventricular / diagnosis*
  • Leukomalacia, Periventricular / mortality
  • Magnetic Resonance Imaging
  • Male
  • Neurologic Examination
  • Neuropsychological Tests
  • North Carolina
  • Probability
  • Retinopathy of Prematurity / diagnosis
  • Retrospective Studies
  • Risk Assessment
  • Survival Rate
  • Tomography, X-Ray Computed