Low-Grade Germinal Matrix Hemorrhage-Intraventricular Hemorrhage and Concomitant Preterm Brain Injuries: Neurodevelopmental Outcomes at 3 Years of Age.

Abstract

To investigate neurodevelopmental outcomes in infants born preterm with low-grade (grade 1 and 2) germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH). Prospectively enrolled 175 infants <32 weeks of gestation underwent early neonatal and/or term-equivalent-age brain magnetic resonance imaging. The presence of GMH-IVH, white matter injury (WMI), and cerebellar hemorrhage (CbH) were graded with quantification of CbH and WMI. Neurodevelopmental assessment was conducted at 3 years. GMH-IVH was detected in 93 (53%); 73 (78%) were low-grade. Compared with infants with no GMH-IVH, infants with low-grade GMH-IVH had higher rates of WMI (17% vs 32%; P = .03) and CbH (15% vs 27%; P = .05). In infants with low-grade GMH-IVH, an interaction was observed with CbH and WMI volume. Low-grade GMH-IVH with CbH >4 mm was associated with lower language scores (β -32.18, 95% CI: -60.37 to -3.99; P = .03) than isolated low-grade GMH-IVH. In infants with low-grade GMH-IVH, greater CbH volumes were associated with lower composite motor (β -0.33, 95% CI: -0.59 to 0.02; P = .07), cognitive (β -0.40, 95% CI: -0.53 to -0.26; P < .001), and language scores (β -0.60 95% CI: -0.98 to -0.22; P = .005). In the presence of WMI volumes >40 mm³, infants with low-grade GMH-IVH had lower motor scores (β -26.72, 95% CI: -47.68 to -5.77; P = .01) after adjusting for gestational age, sex, and maternal education compared with infants with isolated low grade GMH-IVH and no hemorrhage. Although isolated low-grade GMH-IVH did not significantly affect 3-year neurodevelopmental outcomes, concomitant CbH or WMI was associated with poorer outcomes after adjusting for confounders.