AIMS: To evaluate the impact of low-grade intraventricular hemorrhage on neurodevelopmental outcome in preterm infants at 24 months of age. METHODS: We conducted a retrospective case-control study of infants with gestational age less than 34 weeks, admitted to a Neonatal Intensive Care Unit between January/2006 and December/2015. Cases were defined as those with low-grade intraventricular hemorrhage (grades I or II), diagnosed by cranial ultrasonography. For each case, a control with the same gestational age but without intraventricular hemorrhage was selected. Follow-up examinations of neurodevelopment were performed at 24 months of age in cases and controls using the Griffiths Mental Development Scale. Cerebral palsy, neurodevelopmental delay (developmental quotient <2 side deviations below the mean), hearing impairment and/or blindness were considered as severe neurodevelopmental impairment. RESULTS: The study included 172 preterm infants: 86 cases and 86 controls. In the univariate analysis, a difference between the two groups was identified for the following clinical findings: antenatal corticosteroid complete cycle (57% in cases vs. 80% in controls; p=0.001; OR: 0.33, 95%CI 0.17-0.64); male gender (63% cases vs. 41% controls; p=0.004; OR: 2.45, 95%CI 1.3-4.5); outborn (26% cases vs. 9% controls; p=0.005; OR: 3.3 95%CI 1.4-8.0); Clinical Risk Index for Babies higher than 5 (24% in cases vs. 12% in controls; p=0.029; OR: 2.4 95%CI 1.1-5.6); intubation in the delivery room (47% cases vs. 27% controls; p=0.007; OR: 2.38 95%CI 1.3-4.5); and neonatal sepsis (34% in cases vs. 20% in controls; p=0.039; OR: 2.1 95%CI 1.03-4.1). After logistic regression, differences were only maintained for antenatal corticosteroid (p=0.005; OR 0.34, 95%CI 0.16-0.72) and male gender (p=0.002; OR 2.9, 95%CI 1.4-5.8). A severe neurodevelopmental deficit was present in three cases (3.5%) and one control (1.2%). No statistically significant differences in outcome were found between cases and controls. CONCLUSIONS: In this sample, preterm infants with low-grade intraventricular hemorrhage diagnosed by cranial ultrasonography had no difference in early neurodevelopmental outcome when compared with controls.KEYWORDS: cerebral intraventricular hemorrhage; preterm infant; neurodevelopmental disorders. RESUMOOBJETIVOS: Avaliar o impacto da hemorragia intraventricular de baixo grau no neurodesenvolvimento de lactentes prematuros aos 24 meses de idade. MÉTODOS: Foi conduzido um estudo de caso-controle retrospectivo em lactentes com idade gestacional inferior a 34 semanas, internados em uma Unidade de Terapia Intensiva Neonatal entre janeiro de 2006 e dezembro de 2015. Os casos foram definidos como aqueles com hemorragia intraventricular de baixo grau (graus I ou II), diagnosticada por ultrassonografia craniana. Para cada caso, foi selecionado um controle com a mesma idade gestacional, mas sem hemorragia intraventricular. A avaliação do neurodesenvolvimento foi realizada aos 24 meses de idade, em casos e controles, com a Escala de Desen...

Introduction: Severe peri-intraventricular haemorrhage has been associated with higher mortality and neurodevelopmental impairment. The impact of peri-intraventricular haemorrhage alone (without white matter injury) remains controversial. The aim of this study was to evaluate the influence of severe peri-intraventricular haemorrhage, associated or not with cystic peri-ventricular leukomalacia, on mortality and neurodevelopment at 24 months.Material and Methods: Retrospective cohort study, that included newborns with severe peri-intraventricular haemorrhage admitted to a maternity hospital with differentiated perinatal support between 2006 and 2015, and two controls with the same gestational age, without peri-intraventricular haemorrhage, who were admitted immediately after the case. Neurodevelopmental assessment, at 24 months, was performed in 99 children, using the Schedule of Growing Skills II scale in 52 and the Ruth Griffiths mental development scale in 47 children. Severe neurodevelopmental deficit was diagnosed in the following conditions: cerebral palsy, delayed psychomotor development, deafness requiring hearing aids and blindness.Results: The study included 41 cases and 82 controls. Out of these, 23 died, 16 (39.0%) in the group of severe peri-intraventricular haemorrhage and seven (8.5%) in the control group (OR 7.6, 95% CI 2.6 - 20.4, p < 0.001). Severe neurodevelopmental deficit was diagnosed in seven (30.4%) in the severe peri-intraventricular haemorrhage group and one (1.3%) in the control group (OR 32; 95% CI 3.7 - 281, p < 0.001). Individualized analysis showed that mortality was higher in peri-intraventricular haemorrhage grade III with associated cystic peri-ventricular leukomalacia (OR 4.4 95% CI 1.3 - 14.2, p = 0.015) and in peri-intraventricular haemorrhage IV (OR 12; 95% CI 3.5 - 41.2, p < 0.001), when compared to controls. Differences were also noticed regarding severe neurodevelopmental deficit when compared with controls (1.3%) in grade III peri-intraventricular haemorrhage with associated cystic peri-ventricular leukomalacia, (75.0%, p < 0.001) and grade IV peri-intraventricular haemorrhage (50.0%, p < 0.001 ).Discussion: This work showed a higher mortality rate and neurodevelopment impairment in preterm newborns with severe peri-ventricular haemorrhage. Analysis by groups stratified according to gestational age and different grades of peri-ventricular haemorrhage displayed the complications associated with peri-ventricular haemorrhage grade IV or grade III, with or without cystic peri-ventricular leukomalacia.Conclusion: Preterm newborns with peri-intraventricular haemorrhage grade IV or grade III with cystic peri-ventricular leukomalacia, had a higher risk of mortality and severe neurodevelopmental impairment.

Introdução: Pretendeu-se avaliar o neurodesenvolvimento em recém-nascidos pré-termo de muito baixo peso aos 24-30 meses de idade e correlacioná-lo com fatores de risco biológicos e ambientais. Métodos: Estudo observacional, retrospetivo de uma coorte de crianças nascidas entre janeiro de 2005 e dezembro de 2013, com idade gestacional inferior a 32 semanas e/ou peso de nascimento inferior a 1500 g numa maternidade de apoio perinatal diferenciado. Avaliou-se o neurodesenvolvimento aos 24-30 meses através da schedule of growing skills scales II. Considerou--se como existência de sequelas moderadas / graves a presença de paralisia cerebral, quociente de desenvolvimento global inferior a 70, cegueira ou surdez neurossensorial com necessidade de prótese auditiva. Analisaram-se, por regressão logística, os fatores de risco biológicos e ambientais associados significativamente à ocorrência de défice moderado / grave. Resultados: As 551 crianças estudadas apresentavam um peso de nascimento médio de 1222 ± 320 g e idade gestacional média de 29,4 ± 2,3 semanas. Ocorreram 46/551 óbitos (8%). Obteve-se informação do neurodesenvolvimento em 439/505 (87%) crianças. Apresentaram sequelas no neurodesenvolvimento 46/439 (10%): quociente de desenvolvimento global inferior a 70, 29/439 (7%), paralisia cerebral 26/439 (6%), surdez com necessidade de prótese auditiva 8/439 (2%) e um (0,2%) caso de cegueira. No modelo de regressão logística as variáveis que se associaram de modo significativo a sequelas moderadas / graves foram a leucomalácia periventricular quística, baixa escolaridade materna, perímetro craniano inferior ao percentil 3 aos 24-30 meses, malformações congénitas, crianças inseridas em família não convencional e sépsis tardia. Discussão: Fatores biológicos e ambientais são determinantes no neurodesenvolvimento, pelo que devem ser acionadas atempadamente medidas de intervenção nas crianças mais vulneráveis. Palavras-chave:Criança; Distúrbios do Neurodesenvolvimento; Fatores de Risco; Fatores Socioeconómicos; Recém-Nascido de Muito Baixo Peso; Recém-Nascido Prematuro Abstract Introduction: We aimed to assess neurodevelopment outcome in very low birth weight preterm newborns at 24-30 months of age and to correlate it with biological and environmental risk factors. Methods: In an observational case-cohort study of infants born between January 2005 and December 2013, with gestational age less than 32 weeks and/or birth weight less than 1500 g in a maternity hospital with specialised perinatal support, we assessed neurodevelopmental outcome at 24-30 months by means of the Schedule of Growing Skills II. Moderate/severe deficit was considered to be present if the child had cerebral palsy, overall Developmental Quotient less than 70, blindness or profound sensorineural deafness requiring hearing aids. Biological and environmental risk factors independently associated with the presence of moderate/severe deficit were analysed by logistic regression. Results: The 551 children studied had a mean birth weight and gestational age of ...

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