An Overview of Intracranial Hemorrhages in Premature Infants, Risk Factors in Low-Grade Hemorrhages, and an Evaluation of Neurodevelopment with the Bayley III Development Scale: Case-Control Study

This study was prepared based on the findings of Filiz BOLU's thesis study titled “Determining the neurodevelopmental prognosis of preterms with intracranial hemorrhage and the fac- tors affecting the prognosis” ( İ stanbul: Bak ı rköy Gynecology and Pediatrics Training and Research Hospital; 2009). ABS TRACT Objective: Intracranial hemorrhage is a major morbidity in prema- ture infants. We aimed to evaluate the cases with intracranial hemorrhage and to investigate the neurodevelopmental prognosis of prematures with low grade (Grade I-II) hemorrhage and the risk factors affecting it. Material and Methods: Fifty-nine of the 80 cases with intracranial bleeding followed-up in the neonatal inten- sive care unit were evaluated as Grade I-II and 21 as Grade III-IV-periventricular leukomalacia (PVL). Perinatal neonatal problems were investigated in cases with chronological ages of 24-42 months. The effects of risk factors for both Grade III and Grade III-IV-PVL were examined at logistic regression analysis. Cognition, language, and motor domain characteristics were determined with the Bayley III Scale. The relationship with risk and retardation was also examined. Results: Grade I-II and advanced grade hemorrhage cases were similar in terms of mean gestational week, birth weight or chronological age. Logistic regression analysis sho- wed that the risk of hemorrhage increased with intrauterine growth retardation, sepsis and low Apgar scores. Factors affecting Bayley III scores in cases with Grade I-II were low birth weight and gestational week, intrauterine growth retardation, respiratory distress syndrome, ventilator support requirement, sepsis, sei- zure, and transport exposure. The motor domain in particular was affected as birth weight and gestational week decreased. Intrauterine growth retardation affected the cognition domain, respiratory problems, seizure, and transport history affected all domains, and sepsis affected the cognition and language domains. The preva- lence of cerebral palsy and hydrocephaly was 5%, and that of blindness 1.6%. The advanced grade intracranial hemorrhage group scores were very low in all doma- ins. Cerebral palsy was present at a rate of 33%, hydrocephaly at 23.8%, and blindness at 14.2%. Conclusion: Intracranial hemorrhage is an important morbidity of the immature brain in premature infants. Neurodevelopment is adversely affected in both low and advanced grade hemorrhage.