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May 2013

Prognostic Significance of Low-Grade Intraventricular Hemorrhage in the Current Era of Neonatology

Author Affiliations

Author Affiliations: Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Massachusetts.

JAMA Pediatr. 2013;167(5):487-488. doi:10.1001/jamapediatrics.2013.1218

Cranial ultrasonography (CUS) is performed routinely in extremely preterm infants admitted to the neonatal intensive care unit (NICU), and periventricular-intraventricular hemorrhages (PIVHs) are found in approximately 30% of infants born at less than 29 weeks' gestation. Compared with infants with no hemorrhages, infants with intraventricular hemorrhages leading to ventricular dilatation (grade 3 in the Papile classification) or infants with intraparenchymal hemorrhages (grade 4) clearly have higher incidences of cerebral palsy and worse cognitive outcomes. However, the significance of isolated small hemorrhages confined to the germinal matrix (grade 1) or of intraventricular hemorrhages without ventricular dilatation (grade 2) has been less clearly established. Studies evaluating the outcome of infants with these findings have been sparse and have yielded controversial results, and thus there is variability in how the significance of these low-grade hemorrhages is interpreted by neonatologists and conveyed to the parents.