Grading of Intraventricular Hemorrhage and Neurodevelopment in Preterm <29 Weeks’ GA in Canada

Vibhuti Shah; Natasha Musrap; Krishanta Maharaj; Jehier Afifi; Walid El-Naggar; Edmond Kelly; Amit Mukerji; Prakesh Shah; Michael Vincer; Canadian Neonatal Network and Canadian Neonatal Follow-Up Network Investigators

doi:10.3390/children9121948

Grading of Intraventricular Hemorrhage and Neurodevelopment in Preterm <29 Weeks’ GA in Canada

Children (Basel). 2022 Dec 12;9(12):1948. doi: 10.3390/children9121948.

Affiliations

¹ Department of Paediatrics, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada.
² Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada.
³ Department of Paediatrics, Dalhousie University, Halifax, NS B3H 4R2, Canada.
⁴ Department of Pediatrics, McMaster University, Hamilton, ON L8S 3Z5, Canada.

Abstract

Objective: The aim of this study was to evaluate the neurodevelopmental outcome at 18−24 months in surviving preterm infants with grades I−IV intraventricular hemorrhages (IVHs) compared to those with no IVH. Study Design: We included preterm survivors <29 weeks’ GA admitted to the Canadian Neonatal Network’s NICUs from April 2009 to September 2011 with follow-up data at 18−24 months in a retrospective cohort study. The neonates were grouped based on the severity of the IVH detected on a cranial ultrasound scan and recorded in the database: no IVH; subependymal hemorrhage or IVH without ventricular dilation (grades I−II); IVH with ventricular dilation (grade III); and persistent parenchymal echogenicity/lucency (grade IV). The primary outcomes of neurodevelopmental impairment (NDI), significant neurodevelopmental impairment (sNDI), and the effect modification by other short-term neonatal morbidities were assessed. Using multivariable regression analysis, the adjusted ORs (AOR) and 95% of the CIs were calculated. Results: 2327 infants were included. The odds of NDI were higher in infants with grades III and IV IVHs (AOR 2.58, 95% CI 1.56, 4.28 and AOR 2.61, 95% CI 1.80, 3.80, respectively) compared to those without IVH. Infants with an IVH grade ≤II had similar outcomes for NDI (AOR 1.08, 95% CI 0.86, 1.35) compared to those without an IVH, but the odds of sNDI were higher (AOR 1.58, 95% CI 1.16, 2.17). Conclusions: There were increased odds of sNDI in infants with grades I−II IVHs, and an increased risk of adverse NDI in infants with grades ≥III IVHs is corroborated with the current literature.

Keywords: cerebral ultrasound; infant–newborn; neurodevelopmental outcome.

Grants and funding

Organizational support was provided by the Maternal Infant Care Research Centre (MiCare) at Mount Sinai Hospital, Toronto, ON, M5G 1X5, Canada. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CIHR, FRN87518, PBN150642) and in-kind support from Mount Sinai Hospital. Prakesh Shah holds an Applied Research Chair in Reproductive and Child ealth Services and Policy Research awarded by the CIHR (APR-126340). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.