Affiliation:
1. Department of Paediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, Canada; and
2. Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada
Abstract
CONTEXT:
Periventricular/intraventricular hemorrhage (PIVH) is a common short-term morbidity in preterm infants, but its long-term neurodevelopmental impact, particularly with mild PIVH, remains unclear.
OBJECTIVE:
To systematically review and meta-analyze the neurodevelopmental outcomes of preterm infants ≤34 weeks’ gestation with mild and severe PIVH, compared with no PIVH.
DATA SOURCES:
Medline, Embase, CINAHL, and PsychINFO databases from January 2000 through June 2014.
STUDY SELECTION:
Studies reporting long-term neurodevelopmental outcomes based on severity of PIVH were included.
DATA EXTRACTION:
Study characteristics, inclusion/exclusion criteria, exposures, and outcome assessment data extracted independently by 2 coauthors.
RESULTS:
The pooled unadjusted odds ratios of the primary outcome of death or moderate-severe neurodevelopmental impairment (NDI) were higher with both mild (1.48, 95% CI 1.26–1.73; 2 studies) and severe PIVH (4.72, 4.21–5.31; 3 studies); no studies reported adjusted odds ratios. Among survivors, odds of moderate-severe NDI were higher with mild and severe PIVH in both unadjusted (1.75, 1.40–2.20; 3 studies; 3.36, 3.06–3.68; 5 studies) and adjusted (1.39, 1.09–1.77; 3 studies; 2.44, 1.73–3.42; 2 studies) pooled analyses. Adjusted odds of cerebral palsy and cognitive delay were higher with severe but not mild PIVH.
LIMITATIONS:
Only observational studies were included. Fifteen of 21 included studies had a moderate-high risk of bias.
CONCLUSIONS:
Mild and severe PIVH are associated with progressively higher odds of death or moderate-severe NDI compared with no PIVH, but no studies adjusted for confounders. Among survivors, mild PIVH was associated with higher odds of moderate-severe NDI compared with no PIVH.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology and Child Health
Cited by
251 articles.
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