SEVERITY AND OUTCOMES OF INTRACRANIAL HAEMORRHAGES IN VERY LOW BIRTH WEIGHT INFANTS

Objectives: To investigate the incidence and severity of intracranial haemorrhages in very low birth weight infants and evaluate associated neurodevelopmental outcomes at 2 years of postconceptual corrected age. Methods: The subjects of present study were preterm neonates with very low birth weight who were treated at two units of neonatal intensive care in 2012. All infants had serial cranial ultrasound scans. Neurologic development was assessed at the age of 2 using Bayley scale of infant development. Results: During study period 100 very low birth weight infants were available, who underwent cranial ultrasound exams. Intracranial haemorrhage was diagnosed in seventeen patients with following frequencies: 10% III grade intraventricular haemorrhage, 9% haemorrhagic parenchymal infarction (7 of which also had III grade intraventricular haemorrhage, and one with I grade intraventricular haemorrhage), 2% II grade interventricular haemorrhage and 4% I grade intraventricular haemorrhage. From 17 patients with intracranial haemorrhages, 7 (41%) died during neonatal period. Posthaemorrhagic ventriculomegaly and/or porencephalic cysts were found in 3 survived patients with intracranial haemorrgahic lesions (10 from 17). In 5 patients were noted some cystic changes in ventricular system with a tendency for further disappearance. Correlation between interventricular haemorrhage / haemorrhagic parenchymal infarction, absence of antenatal prophylaxis with steroids and need for intubation at birth was found. Neurological development at 2 years of age was evaluated in 9 preterm infants from 10 survived patients. Infantile cerebral palsy was found in 2 patients with II grade intraventricular haemorrhage and 2 with III grade intraventricular haemorrhage and haemorrhagic parenchymal infarction from those 9 preterm infants. Motor problems not connected with infantile cerebral palsy were found in 1 patient with III grade intraventricular haemorrhage. Normal development was noticed in 3 patients with I grade intraventricular haemorrhage and one with small haemorrhagic parenchymal infarction. Conclusions: The incidence of III grade intraventricular haemorrhage and haemorrhagic parenchymal infarction is higher than I and II grade intraventricular haemorrhages. Such finding doesn't match with the majority of publications in western countries. Some preventable risk factors for intraventricular haemorrhage / haemorrhagic parenchymal infarction development were found during this study. The mortality is high in III grade intraventricular haemorrhage and haemorrhagic parenchymal infarction groups. Permanent cerebral lesions with later development of neurologic abnormalities are found in survived patients.