Article Text

Download PDFPDF

243 Twelve year review of grade 4 IVH (extensive and localised) with outcomes
  1. Ashanti Sham Bala Krishnan,
  2. Robin Miralles
  1. UK


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.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.