Background Intraventricular Haemorrhage (IVH) is bleeding into the ventricles and is common in preterm neonates. An increasing grade of IVH is associated with poorer neurological outcomes. Bilateral Grade 4 IVH is associated with the poor prognosis and high rate of cerebral palsy. However recent research has shown that infants with unilateral grade 4 lesions had improved cognitive scores and better overall neurodevelopment outcomes.

Objectives To retrospectively assess outcomes at 2 years according to degree of severity of Grade 4 IVH in preterm infants.

Methods Design: Single-centre tertiary neonatal unit. 64 infants admitted between 2006 and 2019 confirmed to have IVH with parenchymal infarction (Grade 4 IVH).

Method: Extent of infarction (PVHI) was further graded into ‘localised’ or ‘extensive’ (Volpe 2017). Two-year follow up for the inborn infants - Health Status Questionnaire, Schedule of Growing Skills, CP classified by site and GMFCS.

Results Overall mortality 40/64 (63%) - localised group 10/21 (48%); extensive 30/43 (70%).

Mortality was significantly higher in the extensive infarction group (p<0.05).

No infants with bilateral parenchymal infarction survived to discharge (n=8).

Shunt placement in 4 (all extensive). 17/47 inborn survivors (8 extensive, 9 localised).

Two-year outcome data cognitive assessment was available for 10/17. Further information available on 4 others (not yet 24 months).

All infants with extensive infarction had CP (5/5). Localised infarction CP in 3/9 (33%) (p<0.05). Cognitive outcomes (n=10): Normal in 1/3 of extensive group, 6/7 localised group.

Overall disability (n=14): Free of disability in localised group 5/9 (55%), extensive: 0/5 (0%).

Severe disability in localised group 0/9 (0%), extensive 2/5 (40%)

Conclusions Although having a Grade 4 IVH still carries a high mortality rate, significantly better outcomes were seen with a localised Grade 4 IVH, important information in making critical care decisions.