Low-Grade PIVH May Contribute to Subtle Disabilities Later in Life

January 1, 2014

New Findings About Preterm Infants

 Innovations in Pediatrics - Winter 2014 - View Full PDF 

Allison Payne, MD, MS

Neonatologist, UH Rainbow Babies & Children’s Hospital, and Instructor of Pediatrics, Case Western Reserve University School of Medicine

A study from University Hospitals Rainbow Babies & Children's Hospital suggests that preterm infants with low-grade bleeding in the brain have neurodevelopmental outcomes similar to those of preterm infants with no bleeding.

The study's lead author, Allison Payne, MD, MS, a neonatologist at UH Rainbow Babies & Children's Hospital; and Instructor of Pediatrics at Case Western Reserve University School of Medicine, says the large, multicenter study results are similar to outcomes reported by other international cohorts. The study's results differ, however, from those of a recent study that did find differences in outcomes at 18 to 22 months of age in babies with periventricular-intraventricular hemorrhage (PIVH).

PIVH in preterm infants occurs when blood vessels surrounding the fluid-filled parts of the brain rupture. Severe bleeds can cause cognitive or language delays, as well as an increased risk of poor neurosensory outcomes, including cerebral palsy.

While the presence of severe PIVH strongly correlates with adverse motor and cognitive outcomes, little is known about low-grade PIVH. Dr. Payne says her hypothesis is that low-grade bleeding might have more subtle outcomes that may gradually emerge over time, including attention deficit/hyperactivity disorders, specific neuropsychological deficits, organizational problems and behavioral problems.

 

In the study, which appears online in JAMA Pediatrics, researchers analyzed 1,472 extremely preterm infants admitted to 16 pediatric medical centers in the United States, including UH Rainbow Babies & Children's Hospital, from 2006 to 2008. A total of 451 infants were diagnosed with PIVH; of these, 270 presented with low-grade hemorrhage. These 270 children did not have an increased incidence of poor neurodevelopmental outcomes at 18 to 22 months compared with preterm infants without PIVH.

“The clinical importance of this is it helps us counsel parents as to what a child's long-term prognosis may be,” says Dr. Payne. “However, while it is reassuring there are no differences in major deficits at early ages, we need to be cautious about saying there are no differences in outcomes for preterm infants with low-grade hemorrhages since more subtle deficits may show up later on in childhood.”

Dr. Payne plans to follow these children to early school age to determine if there are differences in neurodevelopmental outcomes.

The research was supported by the National Institutes of Health (NIH) through Case Western Reserve University School of Medicine and the Rainbow Babies & Children's Foundation Fellowship Research Award Program. the NIH, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Center for Research Resources and National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network's Generic Database and Follow-Up Studies.

Contact Dr. Payne at Peds.Innovations@UHhospitals.org.

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