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Neurodevelopmental abilities at school-age of a prospective cohort of preterm infants with severe intraventricular haemorrhage and posthaemorrhagic ventricular dilatation

Presented at the Neonatal Society 2016 Autumn Meeting.

Lea CL1,2, Odd D1,3, Young G4,5, Jary S1,2, Aquilina K6, Blair PS2,4, Fernandez AM4,5, Hollingworth W5, Kmita G7, Miller H1, Morgan M8, Pople I3, Smith-Collins A1,2, Thai J9, Williams C5, Whitelaw A1,2, Luyt K1,2

1 School of Clinical Sciences, University of Bristol
2 St. Michael’s Hospital, Bristol
3 North Bristol NHS Trust
4 Bristol Randomised Trials Collaboration
5 School of Social and Community Medicine, University of Bristol
6 Great Ormond Street Hospital
7 University of Warsaw
8 Community Children’s Health Partnership, Bristol
9 Clinical Research and Imaging Centre, Bristol

Background: Preterm infants are routinely screened for intraventricular haemorrhage (IVH) and post haemorrhagic ventricular dilatation (PHVD), however as PHVD is relatively rare, data regarding the long-term neurodevelopmental outcomes are sparse making counselling parents challenging. We present pragmatic outcome data following PHVD associated with grade 3 and grade 4 IVH to support clinicians and families when faced with these results. Data were collected in the DRIFT follow- up study, however this exploratory analysis makes non- randomised comparisons of outcomes at school-age between those who experienced PHVD following grade 3 and those with grade 4 IVH.

Methods: All survivors from the DRIFT trial (n=66) were invited for multi- disciplinary follow-up at school age. Children were aged 8-12years and assessed for ambulatory status using the Gross Motor Function Classification System (GMFCS) and presence of cerebral palsy by neurological examination. Children without cerebral palsy or with GMFCS level 1 or 2 were defined as ambulant. School status (mainstream/special education) was parent reported. Differences between the groups were assessed using logistic regression with grade 3 IVH +PHVD as the reference group.

Results: Mortality after grade 3 IVH+PHVD (group 1) was 9% (3/33) and 22% (8/37) after grade 4 IVH+PHVD (group 2). Of the children assessed at school age (n=52 – 79% of survivors), 27 children were in group 1 and 25 group 2. For these children, median birth weight was 1212(Interquartile range (IQR) 843)g for group 1 and 1040(IQR 370)g for group 2. Gestation at birth was 28(IQR 7)weeks and 27(IQR 2)weeks respectively. 63% (17/27) were ambulant in group 1 vs. only 16% (4/25) in group 2 (OR 0.11; 95% C.I. (0.03, 0.42)). 75% (18/24) were in mainstream school in group 1 vs. 58% (11/19) for children in group 2 (OR 0.46; 95% C.I. (0.13, 1.68)).

Conclusion: Our findings provide practical outcome data on school -age survivors after PHVD. These results better represent modern neonatal medicine, with a larger proportion of extremely preterm infants with more severe brain injury than historical data. This will be valuable for parents, clinicians and for education planning.

Corresponding author: karen.luyt@bristol.ac.uk

Acknowledgements: The DRIFT10 study was funded by the National Institute for Health Research HTA programme (12/35/61) . The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health.

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