High-grade intraventricular hemorrhage in preterm infants is associated with a 74% reduction in survival without severe neurodevelopmental impairment by two years of age, according to a cohort study published in JAMA Network Open.
The study analyzed 26,756 infants born at less than 29 weeks’ gestation in England between 2013 and 2019, using data from the U.K. National Neonatal Research Database. Of these, 8,461 infants were diagnosed with intraventricular hemorrhage (IVH), categorized into low-grade (grades 1–2) and high-grade (grades 3–4) IVH. Incidence rates were 208 per 1,000 live births for low-grade IVH and 108 per 1,000 for high-grade IVH, with only the low-grade increase over time reaching statistical significance (r = 3.6; 95% CI, 0.02–7.3).
High-grade IVH survivors experienced significant functional impairments. Gross motor difficulties affected 44.6%, and communication challenges were observed in 48.9%. The odds of survival without severe neurodevelopmental impairment (NDI) were markedly lower for bilateral high-grade IVH (33.4%) compared to unilateral cases (54.5%). Among survivors with high-grade IVH, 32.8% had no severe NDI, compared to 59.8% in controls (adjusted odds ratio [aOR], 0.26; 95% CI, 0.22–0.31).
Low-grade IVH had a smaller but notable impact, with a 12% reduction in survival without severe NDI (aOR, 0.88; 95% CI, 0.79–0.98). Survivors showed fewer impairments, with 52.2% having no severe NDI. Outcomes worsened with increasing IVH grade and additional conditions like bronchopulmonary dysplasia and necrotizing enterocolitis.
Bilateral injuries and increasing morbidity counts further reduced survival odds. For example, survival without severe NDI was only 24.4% for infants with high-grade IVH and three additional morbidities.
The study highlights that despite advancements in neonatal care, IVH remains a significant clinical challenge, with ongoing monitoring and further research necessary to address associated morbidities. The authors also note the importance of long-term follow-up to evaluate the full impact of IVH on neurodevelopment.
Full disclosures can be found in the published study.
