The Impact of Different Degrees of Intraventricular Hemorrhage on Mortality and Neurological Outcomes in Very Preterm Infants: A Prospective Cohort Study

Cranial Ultrasonography-Standards in Diagnosis of Intraventricular Hemorrhage and Ventricular Dilatation in Premature Neonates

Intraventricular hemorrhage (IVH) is a common complication encountered in extremely-low-birth-weight (ELBW) and very-low-birth-weight (VLBW) premature babies. The neurologic outcome of these patients is influenced by the magnitude of the hemorrhagic process that damages the involved anatomic structures but also by the impaired circulation of cerebrospinal fluid (CSF) through the ventricular system, leading to posthemorrhagic ventriculomegaly (PHVM). Cranial ultrasound (CUS) performed by neonatologists (point-of-care ultrasound-POCUS) facilitates the early diagnosis of IVH and PHVM and can objectively quantify structural alterations. Our aim was to identify the best sonographic criteria to follow-up with ventricular dilatation and predict the need for neurosurgery and neurologic deterioration. We performed a literature review in search of the most relevant ventricular measurements considered by neurosurgeons, neonatologists, and pediatric neurologists to reflect the risk of white matter injury and high intracranial pressure (HIP), thus anticipating neurologic developmental impairment (NDI). The tridimensional picture of ventricular dilatation is best captured if more than one index (ventricular index and anterior horn width) or ratio (Evans ratio, fronto-occipital horn ratio, and fronto-temporal horn ratio) is used. Conclusions: If performed using the correct protocol, serially and comprehensively, CUS is an indispensable tool for the diagnosis and follow-up of neurologic complications of preterm babies, and it can make a difference in guiding adequate intervention and improving long-term developmental outcomes.

Prevalence of intraventricular hemorrhage and associated factors to in premature babies in selected teaching hospitals in Rwanda

Background

Intraventricular hemorrhage (IVH) is a critical issue in premature infants, caused by the rupture of fragile brain blood vessels due to underdeveloped vasculature. IVH severity, graded by the Papile system in 4 grades, significantly impacts neurodevelopmental outcomes. Despite its severity Data on IVH in sub-Saharan Africa, including Rwanda, is limited.

Objective

This study aimed to determine the prevalence of IVH and identify contributing factors among premature infants in selected teaching hospitals in Kigali, Rwanda.

Methodology

A retrospective quantitative study analyzed 416 premature infants admitted to 2 Kigali teaching hospitals from 2020 to 2022. Data on demographics, maternal and neonatal factors, and medical interventions were collected from medical records, and statistical analyses, including chi-square tests and multivariate regression, assessed IVH prevalence and association.

Results

IVH prevalence was 25.0%, with most cases in grades I and II. Significant factors associated with IVH included neonatal transfer, low gestational age, low Apgar scores, low birth weight, respiratory distress syndrome, maternal infections, emergency cesarean sections, and certain invasive medical interventions such as suction and intubation.

Conclusion

This study highlights the complex risk factors for IVH in premature infants, underscoring the need for improved maternal and neonatal care to reduce IVH risk and enhance outcomes. The study’s limitations include its retrospective design, which relies on existing medical records that may contain inaccuracies in documentation, and its focus on data from only two hospitals, potentially limiting the generalizability of the findings. Further research is recommended to validate these results and explore long-term neurological development.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-025-05836-w.

Being born extremely preterm with low-grade intraventricular haemorrhage had no impact on brain volumes or neurodevelopment in later childhood

AIM

Our aim was to investigate the impact that low-grade intraventricular haemorrhage (IVH) had on neonatal morbidities, brain volumes and neurodevelopmental outcomes in children born extremely preterm (EPT) and compare them with children born EPT without low-grade IVH.

METHODS

This prospective cohort study was carried out in Stockholm, Sweden. It focused on 103 children born EPT from 2004 to 2007, at less than 27 weeks of gestation, without major brain injuries. The group with low-grade IVH, defined as grades I-II, were compared with children born EPT without IVH. Around half (45%) underwent MRI scans at 10 years of age and 55% had neurodevelopmental assessments at 12 years.

RESULTS

The low-grade IVH group was sicker during the neonatal period than the children born EPT without IVH. They had lower gestational ages at birth, more days on mechanical ventilation, a higher incidence of necrotising enterocolitis and were more likely to need surgical ligation of patent ductus arteriosus. However, they did not have significantly smaller brain volumes at 10 years of age or worse neurodevelopmental outcomes at 12 years of age.

CONCLUSION

Brain volumes or neurodevelopment were not affected in children born EPT with low-grade IVH, compared to children born EPT without IVH.

Demographic and clinical predictors and inter-center variability of tube feeding in preterm NICU patients

OBJECTIVES

Investigate demographic and clinical factors and inter-center variability associated with home NGT versus GT in preterm infants.

STUDY DESIGN

Retrospective cohort study of preterm infants in the Children's Hospitals Neonatal Database discharged home with a NGT or GT between 2015-2020. Multivariable logistic regression assessed the independent relationship between infant characteristics and feeding modality. Bivariate analysis evaluated inter-center variability.

RESULTS

3521 preterm infants discharged with tube feedings (NGT 39%; GT 61%). Hispanic infants (AOR 1.57, 95% CI 1.15, 2.14) and SGA infants (AOR 1.27, 95% CI 1.02, 1.6) were more likely to receive GT feedings. Privately insured infants had decreased likelihood of receiving GT (AOR 0.57, 95% CI 0.45, 0.72). Infants discharged with NGT had shorter hospital stays (70[34,111] vs. 86 [39,138] days, p < 0.01). Significant inter-center variability among sites exists.

CONCLUSIONS

Differences in tube feeding at discharge were noted by infant race and ethnicity, SGA status, and insurance type.

The prevalence of long-term neurodevelopmental outcomes in preterm-born children in low- and middle-income countries: a systematic review and meta-analysis of developmental outcomes in 72 974 preterm-born children

Background

Preterm birth is associated with an increased risk of adverse neurodevelopmental outcomes. However, prevalence estimates of adverse neurodevelopmental outcomes on preterm born children in low - and middle - income countries (LMICs) remain unclear. In this systematic review and meta-analysis, we aim to estimate the prevalence of adverse neurodevelopmental outcomes in preterm-born children in LMICs.

Methods

We comprehensively searched six electronic databases - Medline, Embase, CINAHL, PsycInfo, Scopus, and Web of Science, without language and date restrictions. We included observational studies conducted in LMICs that reported prevalence of any type of neurodevelopmental outcome in children born preterm using a validated method or clinical diagnosis, and outcome measurement was performed in at least 100 eligible children at age ≥12 months. The primary outcomes of interest were a composite of any neurodevelopmental impairment, cerebral palsy, visual impairment/blindness, hearing impairment/deafness, motor impairment, developmental delays, learning difficulties, and adverse behavioural and socio-emotional outcomes. We used the JBI critical appraisal checklist to assess the quality of the included studies, and prevalence estimates were calculated using a random-effects meta-analysis model.

Results

A total of 47 data sets from 12 countries involving 72 974 preterm-born children were included. The estimated pooled prevalence of overall neurodevelopmental impairment and cerebral palsy was 16% (95% confidence interval (CI) = 11-21%) and 5% (95% CI = 3-6%), respectively. The pooled prevalence of developmental delays across different domains ranged from 8 to 13%. Lower prevalence was found in hearing impairment/deafness and visual impairment/blindness (1%). Higher prevalences were observed with decreasing gestational age and birth weight.

Conclusions

There is a high burden of adverse neurodevelopmental outcomes in preterm born children in LMICs. Such prevalence estimates are essential in informing clinical and public health policy, allocating scarce resources, and directing further research to improved outcomes in these settings.

Registration

PROSPERO: CRD42024569564.

Posterior subependymal germinal matrix hemorrhage as a mild form of hemorrhage in extremely preterm infants: neurodevelopmental outcomes at corrected ages of 18-24 months

PURPOSE

This study aimed to explore the effects of both the presence and size of posterior subependymal germinal matrix hemorrhage (PS-GMH), considered a mild form of hemorrhage, on the neurodevelopmental outcomes of extremely preterm infants.

METHODS

A retrospective analysis was conducted on 221 extremely preterm infants, assessing their initial and term-equivalent age (TEA) cranial ultrasound (cUS) examinations from 2016 to 2021. Infants were classified based on the presence and size (small/large) of PS-GMH. Neurodevelopmental outcomes at corrected ages of 18-24 months were analyzed in 135 infants.

RESULTS

PS-GMH was identified in 86.9% (192/221) of the infants, with 13.5% (26/192) exhibiting large PS-GMH. Among the 135 infants who were followed up, those with PS-GMH were found to have younger gestational ages (P<0.001) and a higher incidence of maternal chorioamnionitis (P=0.016) than those without PS-GMH. Significant differences were observed in the incidence of grade II intraventricular hemorrhage (IVH) on initial cUS (P=0.003) and ventriculomegaly at TEA cUS (P=0.026) across the groups with no PS-GMH, small PS-GMH, and large PS-GMH. The large PS-GMH group exhibited a higher occurrence of grade II IVH than the small PS-GMH group (P=0.006). However, ventriculomegaly incidence did not significantly vary with PS-GMH status. Neurodevelopmental outcomes were also not significantly different across PS-GMH statuses. The adjusted odds ratios for any neurodevelopmental impairment, compared to the no PS-GMH group, were 1.70 (95% confidence interval [CI], 0.40 to 7.26; P=0.471) for all PS-GMH, 1.61 (95% CI, 0.37 to 6.93; P=0.526) for small PS-GMH, and 3.84 (95% CI, 0.62 to 24.00; P=0.150) for large PS-GMH.

CONCLUSION

PS-GMH was frequently observed in extremely preterm infants; however, it did not independently predict adverse neurodevelopmental outcomes.

Development of a machine learning model for prediction of intraventricular hemorrhage in premature neonates

PURPOSE

Intraventricular hemorrhage (IVH) is a common and severe complication in premature neonates, leading to long-term neurological impairments. Early prediction and identification of risk factors for IVH in premature neonates are crucial for improving clinical outcomes. This study aimed to predict IVH in premature neonates and determine risk factors using machine learning (ML) algorithms.

METHODS

This study investigated the medical records of premature neonates admitted to the neonatal intensive care unit. The patients were labeled as case (IVH) and control (No IVH). The independent variables included demographic, clinical, laboratory, and imaging data. Machine learning algorithms, including random Forest, support vector machine, logistic regression, and k-nearest neighbor, were used to train the models after data preprocessing and feature selection. The performance of the trained models was evaluated using various performance metrics.

RESULTS

Data from 160 premature neonates were collected including 70 patients with IVH. The identified risk factors for IVH were the gestational age, birth weight, low Apgar scores at 1 min and 5 min, delivery method, head circumference, and various laboratory findings. The random forest algorithm demonstrated the highest sensitivity, specificity, accuracy, and F1 score in predicting IVH in premature neonates, with a great area under the receiver operating characteristic curve of 0.99.

CONCLUSION

This study revealed that the random forest model effectively predicted IVH in premature neonates. The early identification of premature neonates at higher risk of IVH allows for preventive measures and interventions to reduce the incidence and morbidity of IVH in these patients.

Impact of perinatal factors on T cells and transcriptomic changes in preterm infant brain injury

BACKGROUND

T cells have been implicated in various neurological conditions, yet their role in neonatal brain injuries remains unclear. This study aimed to investigate the impact of perinatal factors on frequencies of T cell subsets in preterm infants and to explore the differences in blood genome expression profiles between preterm infants with and without brain injury.

MATERIALS AND METHODS

Three cohorts of preterm infants were used. Blood samples were collected soon after birth for the first cohort and late timepoint for the second and third cohorts. In the first cohort (88 infants), flow cytometry measured the proportions of αβT and γδT cell subsets in peripheral blood, analyzing associations with gestational age, birth weight, sex, delivery type, and maternal conditions. The second cohort focused on the relationship between T cell subsets and brain injury. In the third cohort, transcriptome sequencing identified differentially expressed genes and pathways in infants with brain injury, highlighting immune-related changes.

RESULTS

Infants born at 29-30 weeks or with a birth weight of 1000-1500 g had significantly higher proportions of Vδ2+ T cells compared to those born at 30-32 weeks or with a birth weight > 1500 g, while no significant difference was found between infants born at < 29 weeks or with a birth weight < 1000 g. A negative correlation was observed between gestational age and Vδ2+ T cell frequency. No significant associations were found between Vδ2+ T cell proportions and perinatal factors other than gestational age or brain injury. Blood transcriptome analysis revealed 173 differentially expressed genes, characterized by downregulated interferon signaling and upregulated antimicrobial and neutrophil pathways in infants with brain injury.

CONCLUSIONS

Gestational age and birth weight influence Vδ2+ T cell proportions in preterm infants, likely reflecting immune maturation. While no direct link to brain injury was found, altered immune pathways suggest potential biomarkers for prognosis, warranting further research into their roles and therapeutic implications in neonatal brain injuries.

Diagnostic Accuracy of Cranial Ultrasound for the Detection of Intracranial Hemorrhage in Preterm Neonates Using Magnetic Resonance Imaging As the Gold Standard

Background and objective Intracranial hemorrhage (ICH) and white-matter damage are the main brain injuries in preterm infants. Magnetic resonance imaging (MRI) is the best way to examine cerebral bleeding. The evidence on cranial ultrasound diagnostic accuracy in neonates is limited in Pakistani publications, which show variability in evidence, necessitating the present study. The aim is to find out the diagnostic accuracy of cranial ultrasound for detecting ICH in preterm neonates, taking MRI as the gold standard. Methodology A cross-sectional study was carried out in the Department of Radiology, The Children's Hospital, Lahore, Pakistan, from June 19, 2018 to December 18, 2018. The study involved 103 preterm neonates of both genders aged between 1 and 27 days and presenting with suspicion of ICH. The cranial ultrasound with MRI (gold standard) was used to diagnose ICH, and the results of the cranial ultrasound were assessed accordingly. The diagnostic performance of ultrasound was estimated using parameters, e.g., sensitivity, specificity, accuracy, and positive and negative predictive values. The p < 0.05 was taken as statistically significant. Results The neonates had a mean age of 9.9 ± 6.6 days. There were 53 (51.5%) male and 50 (48.5%) female neonates. The cranial ultrasound diagnosed ICH in 39 (37.9%) neonates, which is confirmed by MRI as the gold standard. Cranial ultrasound had 100.0% sensitivity, 90.62% specificity, 94.17% accuracy, 86.67% positive predictive value, and 100.0% negative predictive value for detecting ICH in preterm neonates. Similar diagnostic performance was seen across age and gender groups (p > 0.05). Conclusion Cranial ultrasound was 100% sensitive, 90.6% specific, and 94.2% accurate in identifying cerebral bleeding in preterm neonates. The noninvasive, ionizing radiation-free nature and availability at the bedside of cranial ultrasound make it a promising future modality.

Incidence and Risk Factors of Intraventricular Hemorrhage in Early Preterm Infants: A Cross-Sectional Study

BACKGROUND

Early preterm infants are susceptible to a serious disorder called intraventricular hemorrhage (IVH), which may cause severe neurological damage.

OBJECTIVE

To determine the incidence of IVH in preterm infants at Lady Reading Hospital, Peshawar, Pakistan, and to identify associated risk factors and potential preventive measures.

METHODOLOGY

This cross-sectional research examined the prevalence of IVH among early preterm infants and was carried out at Lady Reading Hospital in Peshawar from 1 January 2021 to 31 December 2023. After excluding individuals with congenital defects, insufficient medical records, or non-consent, the research comprised 210 newborns born before 28 weeks of gestation and diagnosed with IVH during the first 72 hours of life. Medical record reviews and in-person observations were used to gather data, with an emphasis on clinical, risk, and demographic characteristics. Using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY) with a significance threshold of p < 0.05, descriptive techniques were used in the statistical studies to summarize the features and inferential approaches, such as univariate and multivariate logistic regression, to identify IVH risk variables.

RESULTS

Among the 210 early preterm newborns studied, the frequency of IVH according to severity was as follows: 79 infants (37.62%) had Grade I, 65 infants (30.95%) had Grade II, 39 infants (18.57%) had Grade III, and 27 infants (12.86%) had Grade IV. Three key demographic findings were that 63 births (30.00%) occurred before 26 weeks of gestation, 87 infants (41.43%) had birth weights of less than 1000 grams, and 111 infants (52.86%) were male. Significant predictors of IVH identified through multivariate logistic regression included birth weight less than 1000 grams (odds ratio (OR) = 3.10, 95% confidence interval (CI): 1.78-5.42, p < 0.01), gestational age less than 26 weeks (OR = 2.68, 95% CI: 1.50-4.76, p < 0.01), Apgar score ≤5 (OR = 4.01, 95% CI: 2.23-7.21, p < 0.01), resuscitation at birth (OR = 2.23, 95% CI: 1.12-4.45, p = 0.02), mechanical ventilation (OR = 3.55, 95% CI: 1.85-6.82, p < 0.01), and sepsis (OR = 2.98, 95% CI: 1.50-5.92, p = 0.02).

CONCLUSION

The high incidence of IVH and its association with critical risk factors underscore the need for improved neonatal care practices and targeted interventions in early preterm infants.

Experience in endoscope choice for neuroendoscopic lavage for intraventricular hemorrhage of prematurity: a systematic review

OBJECTIVE

Intraventricular hemorrhage (IVH) of prematurity occurs in 20-38% of infants born < 28 weeks gestational age and 15% of infants born in 28-32 weeks gestational age. Treatment has evolved from conservative management and CSF diversion of temporizing and shunting procedures to include strategies aimed at primarily clearing intraventricular blood products. Neuroendoscopic lavage (NEL) aims to decrease the intraventricular blood burden under the same anesthetic as temporizing CSF diversion measures in cases of hydrocephalus from IVH of prematurity. Given the variety of neuroendoscopes, we sought to review the literature and practical considerations to help guide neuroendoscope selection when planning NEL.

METHODS

We conducted a systematic review of the literature on neuroendoscopic lavage in IVH of prematurity to examine data on the choice of neuroendoscope and outcomes regarding shunt rate. We then collected manufacturer data on neuroendoscopic devices, including inflow and outflow mechanisms, working channel specifications, and tools compatible with the working channel. We paired this information with the advantages and disadvantages reported in the literature and observations from the experiences of pediatric neurosurgeons from several institutions to provide a pragmatic evaluation of international clinical experience with each neuroendoscope in NEL.

RESULTS

Eight studies were identified; four neuroendoscopes have been used for NEL as reported in the literature. These include the Karl Storz Flexible Neuroendoscope, LOTTA® system, GAAB system, and Aesculap MINOP® system. The LOTTA® and MINOP® systems were similar in setup and instrument options. Positive neuroendoscope features for NEL include increased degrees of visualization, better visualization with the evolution of light and camera sources, the ability to sterilize with autoclave processes, balanced inflow and outflow mechanisms via separate channels, and a working channel. Neuroendoscope disadvantages for NEL may include special sterilization requirements, large outer diameter, and limitations in working channels.

CONCLUSIONS

A neuroendoscope integrating continuous irrigation, characterized by measured inflow and outflow via separate channels and multiple associated instruments, appears to be the most commonly used technology in the literature. As neuroendoscopes evolve, maximizing clear visualization, adequate inflow, measured outflow, and large enough working channels for paired instrumentation while minimizing the footprint of the outer diameter will be most advantageous when applied for NEL in premature infants.

Sustained acute kidney injury as an independent risk factor for neurodevelopmental and growth outcomes in a single NICU center

PURPOSE

Acute kidney injury (AKI) is commonly seen in neonatal intensive care units (NICUs) and is potentially associated with adverse prognoses in later stages of life. Our study evaluated the impact of sustained AKI (SAKI) on both neurodevelopmental impairment (NDI) and early growth restriction (EGR) in neonates.

METHODS

This case-control study retrospectively analyzed the medical records of neonates diagnosed with SAKI in the NICU of a tertiary medical center during the period from January 2007 to December 2020. Cases without subsequent follow-up and those resulting in death were excluded. We analyzed demographic, biochemical, and clinical outcome data.

RESULTS

Of the 93 neonates with SAKI, 51 cases (54.8%) were included in this study, while 42 cases (45.2%) were excluded due to a lack of follow-up or death. An age-matched control group comprised 103 neonates, who had never experienced AKI or SAKI, were selected at random. In total, 59 (38.3%) cases were identified as NDI and 43 (27.9%) as EGR. Multivariate analysis revealed that patients with SAKI had significantly higher risks of developing NDI (odds ratio, [OR] = 4.013, p = 0.001) and EGR (OR = 4.894, p < 0.001). The AKI interval had an area under the receiver operating characteristic curve of 0.754 for NDI at 9.5 days and 0.772 for EGR at 12.5 days.

CONCLUSIONS

SAKI is an independent risk factor for both NDI and EGR in neonates. Consequently, regular monitoring, neurological development assessments, and appropriate nutritional advice are crucial to these infants who have experienced renal injury.

Hydrocephalus in prematurity: does valve choice make a difference?

PURPOSE

Extremely premature neonates diagnosed with post-haemorrhagic hydrocephalus (PHH) are recognised to have particularly poor outcomes. This study assessed the impact of a number of variables on outcomes in this cohort, in particular the choice of shunt valve mechanism.

METHODS

Electronic case notes were retrospectively reviewed of all premature neonates admitted to our centre for management of hydrocephalus between 2012 and 2021. Data included (i) gestational age, (ii) birth weight, (iii) hydrocephalus aetiology, (iv) surgical intervention, (v) shunt system, (vi) 'surgical burden' and (vii) wound failure and infection rate. Data was handled in Microsoft Excel and statistical analysis performed in SPSS v27.0 RESULTS: N = 53 premature hydrocephalic patients were identified (n = 28 (52.8%) female). Median gestational age at birth was 27 weeks (range: 23-36 + 6 weeks), with n = 35 extremely preterm patients and median birth weight of 1.9 kg (range: 0.8-3.6 kg). Total n = 99 programmable valves were implanted (n = 28 (28.3%) de novo, n = 71 (71.2%) revisions); n = 28 (28.3%) underwent n ≥ 1 pressure alterations, after which n = 21 (75%) patients had symptoms improve. In n = 8 patients exchanged from fixed to programmable valves, a mean reduction of 1.9 revisions per patient after exchange was observed (95%CI: 0.36-3.39, p = 0.02). Mean overall shunt survival was 39.5 weeks (95%CI: 30.6-48.5); 33.2 weeks (95%CI: 25.2-41.1) in programmable valves and 35.1 weeks (95%CI: 19.5-50.6) in fixed pressure (p = 0.22) with 12-month survival rates of 25.7% and 24.7%, respectively (p = 0.22). Shorter de novo shunt survival was associated with higher operation count overall (Pearson's R: - 0.54, 95%CI: - 0.72 to - 0.29, p < 0.01). Wound failure, gestational age and birth weight were significantly associated with shorter de novo shunt survival in a Cox regression proportional hazards model; gestational age had the greatest impact on shunt survival (Exp(B): 0.71, 95%CI: 0.63-0.81, p < 0.01).

CONCLUSION

Hydrocephalus is especially challenging in extreme prematurity, with a shorter de novo shunt survival associated with higher number of future revisions. Programmable valves provide flexibility with regard to pressure setting, with the potential for fewer shunt revisions in this complex cohort.

Neurodevelopmental outcomes in preterm or low birth weight infants with germinal matrix-intraventricular hemorrhage: a meta-analysis

BACKGROUND

This meta-analysis aimed to identify the near- and long-term neurodevelopmental prognoses of preterm or low birth weight (LBW) infants with different severities of intraventricular hemorrhage (IVH).

METHODS

Four databases were searched for observational studies that were qualified using the Newcastle-Ottawa Scale.

RESULTS

37 studies involving 32,370 children were included. Compared to children without IVH, children with mild IVH had higher incidences of neurodevelopmental impairment (NDI), cerebral palsy (CP), motor/cognitive delay, hearing impairment and visual impairment, as well as lower scores of the mental development index (MDI) and psychomotor development (PDI). Moreover, compared to mild IVH, severe IVH increased susceptibilities of children to NDI, motor delay, CP, hearing impairment and visual impairment, with worse performances in MDI, PDI, motor score and IQ. Mild IVH was not associated with seizures or epilepsy.

CONCLUSIONS

Adverse neurodevelopmental outcomes positively associated with the occurrence and severity of IVH in preterm or LBW infants, providing evidence for counseling and further decisions regarding early therapeutic interventions.

IMPACT

Adverse neurodevelopmental outcomes later in life were closely associated with the occurrence and severity of IVH in preterm or LBW infants. Our results highlight the importance to make prediction of the neurodevelopmental outcomes of children born preterm or LBW with a history of IVH, which will guide affected parents when their children need clinical interventions to reach the full potential. We emphasize the importance of identifying specific developmental delays that may exist in children with IVH, providing detailed information for the development of comprehensive intervention measures.

The association of cumulative vasoactive drugs and neurodevelopmental outcomes in preterm Infants <29 weeks gestation

OBJECTIVE

To assess the effect of cardiovascular medications on the neurodevelopment of preterm infants, as measured by calculated cumulative time of vasoactive-inotropic score (VISct).

METHODS

A retrospective study was conducted on preterm infants who developed significant hypotension defined as a mean BP more than 2SDs below the mean for GA and received treatment with duration > 6 hours for each hypotensive episode, we calculated the vasoactive inotropic score (VIS) and cumulative exposure to cardiovascular medications over time (VISct). The composite Bayley III was reported from the high-risk follow-up clinic for the surviving infants between 18 to 21 months corrected age.

RESULTS

VISct was significantly higher in infants with abnormal neurodevelopment. Cognitive Bayley was the most affected component with median (IQR) VISct 882.5(249,2047) versus 309(143,471) (p-value 0.012), followed by language function with VISct 786(261,1563.5), versus 343(106.75,473.75) (p-value 0.016) when those with Bayley III <85 were compared with those with normal Bayley IIIs.

CONCLUSION

High VISct scores may have negative effect on cognitive and language neurodevelopmental outcomes.

Short-term prognosis of very-preterm infants of ethnic minorities and Han nationality at high altitude: a single-center, retrospective study

OBJECTIVE

We aimed to analyze the perinatal care of very-preterm infants (VPIs) in plateau areas of China and to explore any differences in short-term outcomes between ethnic minorities and Han nationality.

METHODS

VPIs with gestational age (GA) <32 weeks admitted to Qinghai Red Cross Hospital from 1 January 2018 to 31 December 2020 were enrolled. Maternal information, neonatal information, perinatal care and discharge outcomes were retrospectively collected and analyzed.

RESULTS

A total of 302 VPIs were examined, including 143 (47.4%) ethnic minority infants and 159 (52.6%) Han infants. Mothers of ethnic minority infants were significantly younger than those of Han infants (27 y vs. 30 y, p < .001). There were no differences in the incidence of assisted reproduction, multiple pregnancies, maternal hypertension, clinical chorioamnionitis or premature rupture of membranes >18 h between ethnic minority mothers and Han mothers. Lower proportions of cesarean section and incidence of maternal diabetes were observed in ethnic minority mothers than in Han mothers [(9.1 vs.17.6%, p < .05) and (42.7 vs. 57.9%, p < .05, respectively)]. Meanwhile, fewer antenatal steroids were used in minority group than Han group (65.7 vs. 81.1%, p < .05). No significant differences in rates of death, active treatment, necrotizing enterocolitis stage ≥2, moderate-to-severe BPD, and incidence of severe retinopathy of prematurity in VPIs were found between the two groups and in all GA subgroups. Severe neurological injury was significantly less common in the minority newborns than in the Han infants (1.2 vs. 6.1%, p < .05). Compared with Han group, no excess risk of death, death or major morbidity, death despite active treatment, death or major morbidity despite active treatment was observed in ethnic minorities, with or without adjusting for gestational age and prenatal steroids.

CONCLUSIONS

Short-term prognosis of VPIs of ethnic minorities were similar to those of Han nationality.

Association between bronchopulmonary dysplasia and death or neurodevelopmental impairment at 3 years in preterm infants without severe brain injury

Objective

We investigated the association between bronchopulmonary dysplasia (BPD) and 3 years death or neurodevelopmental impairment (NDI) in very preterm infants without severe brain injury.

Method

Our prospective cohort study recruited preterm infants who were born prior to 32 weeks of gestational age and survived in the neonatal intensive care unit until 36 weeks of corrected age. Upon reaching 3 years of age, each infant was assessed for death or NDI such as cerebral palsy, cognitive deficit, hearing loss, and blindness. Correlations between BPD and death or NDI were determined using multiple logistic regression analyses adjusted for confounding factors.

Result

A total of 1,417 infants without severe brain injury who survived until 36 weeks of corrected age were initially enrolled in the study. Over the study period, 201 infants were lost to follow-up and 5 infants were excluded. Our final dataset, therefore, included 1,211 infants, of which 17 died after 36 weeks of corrected age and 1,194 were followed up to 3 years of age. Among these infants, 337 (27.8%) developed BPD. Interestingly, by 3 years of age, BPD was demonstrated to be independently associated with death or NDI, with an adjusted odds ratio of 1.935 (95% confidence interval: 1.292-2.899, p = 0.001), in preterm infants without severe neonatal brain injury.

Conclusion

Our findings indicate that BPD is strongly associated with death or NDI in preterm infants without severe neonatal brain injury at 3 years of age. Further research is needed to understand the mechanisms linking the development of BPD with death or NDI and whether appropriate treatment of BPD may ameliorate or prevent the development of neurological complications.

Risk Factors for Neurodevelopmental Impairment at 2- and 5-Years Corrected Age in Preterm Infants with Established Bronchopulmonary Dysplasia

INTRODUCTION

The objective of this study was to identify risk factors for neurodevelopmental impairment (NDI) at 2- and 5-years corrected age (CA) in a cohort of preterm infants with established bronchopulmonary dysplasia (BPD).

METHODS

This single-center retrospective cohort study included infants born between 2009 and 2016 at a gestational age (GA) <30 weeks with moderate or severe BPD at 36 weeks' postmenstrual age. Perinatal characteristics, (social) demographics, and comorbidities were collected from the electronic patient records. Odds ratios for NDI were calculated with univariate and multivariate logistic regression analyses adjusting for potential confounders.

RESULTS

Of the 602 eligible infants, 123 infants were diagnosed with BPD. NDI was present in 30.3% and 56.1% at 2- and 5-years CA, respectively. The only independent risk factors associated with NDI in the multivariate analyses were birthweight (adjusted odds ratio [aOR] 0.74, 95% CI 0.57-0.95; aOR 0.70, 95% CI 0.54-0.91, respectively), small for GA (SGA) (aOR 3.25, 95% CI 1.09-9.61; aOR 5.44, 95% CI 1.62-18.2, respectively) at both time points, and male gender at 5-years CA (OR 2.49, 95% CI 1.11-5.57).

CONCLUSION

Birthweight and SGA are independent risk factors for NDI at 2- and 5-years CA and male gender at 5-years CA in preterm infants with BPD. In contrast, well-known other risk factors for NDI in the general population of preterm infants, such as GA, maternal education, and neonatal comorbidities were not independently associated with NDI.

Clinical characteristics and long-term neurodevelopmental outcomes of leukomalacia in preterm infants and term infants: a cohort study

BACKGROUND

Leukomalacia is a serious form of neonatal brain injury that often leads to neurodevelopmental impairment, and studies on neonatal leukomalacia and its long-term outcomes are lacking. The aim of this study was to analyze the clinical manifestations, imaging features, and long-term neurodevelopmental outcomes in preterm infants and term infants with leukomalacia.

METHODS

Newborns diagnosed with leukomalacia by head magnetic resonance imaging (MRI) and who were admitted to intensive care units from January 2015 to June 2020 were enrolled. All infants were followed up to June 2022 (2-7 years old), and their neurodevelopmental outcomes were evaluated. The clinical data and long- term outcomes of preterm infants and term infants was analyzed by Chi-square tests.

RESULTS

A total of 218 surviving infants with leukomalacia including 114 preterm infants and 104 term infants completed the follow-up. The major typesof leukomalacia on MRI were periventricular leukomalacia in the preterm group and subcortical cystic leukomalacia in the term group, respectively (χ2 = 55.166; p < 0.001). When followed up to 2-7 years old, the incidence of neurodevelopmental impairment in the preterm group and term group was not significantly different (χ2 = 0.917; p = 0.338). However, the incidence of cerebral palsy (CP) in the preterm group was significantly higher (χ2 = 4.896; p = 0.027), while the incidence of intellectual disability (ID) (χ2 = 9.445; p = 0.002), epilepsy (EP) (χ2 = 23.049; p < 0.001), and CP combined with ID andEP (χ2 = 4.122; p = 0.042) was significantly lower than that in the term group.

CONCLUSIONS

Periventricular leukomalacia mainly occurred in preterm infants while subcortical cystic leukomalacia was commonly seen in term infants. Although the long-term neurodevelopmental outcomes of leukomalacia were both poor, preterm infants were more prone to CP, while term infants were more prone to ID, EP, and the combination of CP with ID and EP.

Neurodevelopmental Outcome of Very Low Birth Weight Infants in the Northern District of Israel: A Cross-Sectional Study

BACKGROUND

Currently, no local database in Israel collects neurodevelopmental outcomes of very low birth weight (VLBW) preterm infants. We investigated neurodevelopmental outcomes in one district of the largest healthcare organization in Israel.

METHODS

A cross-sectional study including all VLBW (<1500 g) preterm infants born between 1 January 2006 and 31 December 2016 who were followed in any of seven child development centers in Israel's Northern District. Data were retrospectively collected from the computerized medical record database.

RESULTS

Out of 436 participants, 55.1% had normal developmental outcomes. A total of 8.9% had cerebral palsy (CP), 12.2% had a global developmental delay (GDD), and 33.4% had a language delay. Out of the extremely preterm infants (n = 109), 20.2% had CP, 22.0% had GDD, and 44.9% had language delay. We found a statistically significant higher rate of abnormal neurodevelopment outcomes in non-Jews compared to Jews (57% vs. 37.8%, respectively, p < 0.0001).

CONCLUSIONS

We found a relatively high overall rate of CP in our local population and a significant difference in neurodevelopmental outcomes between Jews and non-Jews. This study emphasizes the need for an expanded and detailed national database collecting post-discharge outcomes, as well as an assessment of national healthcare resource allocation and inequalities in preterm infants' post-discharge care.

The Regulated Cell Death and Potential Interventions in Preterm Infants after Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) in preterm infants is one of the major co-morbidities of preterm birth and is associated with long-term neurodevelopmental deficits. There are currently no widely accepted treatments to prevent ICH or therapies for the neurological sequelae. With studies broadening the scope of cell death, the newly defined concept of regulated cell death has enriched our understanding of the underlying mechanisms of secondary brain injury after ICH and has suggested potential interventions in preterm infants. In this review, we will summarize the current evidence for regulated cell death pathways in preterm infants after ICH, including apoptosis, necroptosis, pyroptosis, ferroptosis, autophagy, and PANoptosis as well as several potential intervention strategies that may protect the immature brain from secondary injury after ICH through regulating regulated cell death.

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

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.