Neonatal Neurology Fellow The Hospital for Sick Children York, Ontario, Canada
Background: The neurodevelopmental outcomes of low-grade germinal matrix-intraventricular hemorrhage (GMH-IVH) in preterm neonates remain unclear and inconsistent in the literature. Objective: Our aim was to evaluate the neurodevelopmental outcomes at 3 years of age in very preterm infants with low-grade GMH-IVH. Design/Methods: Prospectively enrolled preterm infants < 32 weeks’ gestation underwent early-life and term-equivalent-age MRI. Serial cranial ultrasound scans were structurally reviewed. The presence of GMH-IVH, white matter injury (WMI), and cerebellar hemorrhage (CBH) were assessed. GMH-IVH was classified as low-grade (grade-1 and grade-2) and high-grade (grade-3 and grade-4). Neurodevelopmental assessment was done with Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) at 3 years Results: 170 preterm infants (mean ± standard deviation gestational age [GA] 27.3 ± 2.4 weeks) were included. GMH-IVH was present in 91 infants (54%), of whom 71 (78%) were low-grade. Compared with controls, infants with low-grade GMH-IVH had lower GA, a higher rate of intubation requirement at birth, prolonged mechanical ventilation, hemodynamically significant patent ductus arteriosus requiring treatment and hypotension (p < 0.05 for all). Infants with GMH-IVH had higher rates of CBH (28% vs. 13%, p=0.02) and WMI (31% vs. 17%, p=0.04) and had similar cognitive, language, and motor scores (median [IQR]) on Bayley-III as those without GMH-IVH (95 [90-100] vs. 95 [86-100], p=0.6; 97 [89-100] vs. 100 [92-106], p=0.3; 91 [82-97] vs. 96 [85-100], p=0.2).
Conclusion(s): Low-grade GMH-IVH was associated with lower GA and higher rates of perinatal cardiorespiratory complications and brain injury. However, low-grade GMH-IVH was not associated with lower neurodevelopmental scores at 3 years of age.
