Association of Low-Grade Intraventricular Haemorrhage with MRI Findings at Term Equivalent Age and Severe Neurodevelopmental Impairment

Background: In premature neonates, the evidence regarding the risk of white matter damage and neurological impairment following an uncomplicated intraventricular haemorrhage (IVH) remains inconclusive.

Objective: To evaluate any association of IVH I-II with the brain MRI findings at term equivalent age (TEA), and the neurodevelopmental outcome.

Methods: We retrospectively reviewed the medical records of all neonates ≤32 weeks’ gestation admitted to the Neonatal Unit of University Hospital of Ioannina, during 2010-2017. Neonates with IVH I-II were included, and compared with neonates without IVH. All neonates had neurodevelopmental assessment at two years of corrected age. Those with congenital anomalies, IVH III-IV, cystic periventricular leukomalacia (cPVL) or infarct detected in ultrasound were excluded.

Results: Totally 133 neonates were enrolled; 40 neonates of 29±2 weeks’ gestation with IVH I-II, and 93 controls of 29.5±1.7 weeks’ gestation (p=0.163).

Among the perinatal characteristics examined between the two groups, neonates with IVH had haemodynamically significant PDA in higher proportion (23 over 8%, p=0.004) and required ventilation for longer (10 over 4 days, p=0.032) compared to controls, however, they had similar rates of bronchopulmonary dysplasia and were discharged in similar corrected age.

The 113 (85%) neonates had an MRI; 33 with IVH and 80 controls. Abnormal findings detected in 2 (6%) neonates with IVH (1 had diffuse PVL-dPVL and 1 infarct), and in 8 (11%) controls (6 had dPVL and 2 cPVL).

Cerebral palsy was diagnosed in one infant of 30 weeks’ gestation with IVH I and normal MRI, and another of 24.3 weeks’ gestation with normal ultrasound but cPVL in MRI.

Conclusions: Premature neonates with IVH I-II have similar findings in MRI compared to neonates without IVH. Furthermore, they are in the same low risk for cerebral palsy.