Long-term neurodevelopmental outcome following low grade intraventricular hemorrhage in premature infants

Background: Intraventricular hemorrhage (IVH) is one of the most formidable neurological complications in premature infants. Low grade IVH is often regarded as a low risk factor for long-term neurological impairment. Methods: We retrospectively investigated, if there was an association of low IVH grade and adverse neurological outcome in survivors at 20-24 months of corrected age. Results: 89 infants, median gestational age 27 + 4, were included in the study. In total 55 children with IVH grade I (n = 34) or grade II (n = 21), plus 34 children with IVH grade III (n = 13) and IVH grad IV (n = 21) were included. In infants with grade I and II IVH median mental developmental index (MDI) and psychomotor developmental index (PDI) were 90 and 88, respectively. In total 18 children (33%) had a MDI one standard deviation below the mean ( < 85, < 1SD). 9 out of these 18 had an IVH grade I. 17 infants (31%) had a PDI < 1SD. An MDI/PDI < 2SD was only found in 7 (13%)/6 (11%) children, respectively. Regression analysis showed that IVH grade (p < 0,001) and gestational age (p = 0,008) were significant independent risk factors for an adverse motoric outcome. Conclusion: Our collective revealed that an IVH grade I was not always associated with a good outcome. Interpretation and prediction of long outcome prognosis after IVH grade I or II requires careful consideration as it might be associated with increased disability.