Incidence and neurodevelopmental outcome of periventricular hemorrhage and hydrocephalus in a regional population of very low birth weight infants.

During the years 1984 to 1987, 459 very low birth weight (VLBW) infants were admitted to a state-designated Level III Neonatal Intensive Care Unit. Cerebral sonography performed in a standardized sequence and graded with the Papile scale diagnosed 97 (21.1%) children with periventricular hemorrhage (PVH). The incidence of PVH declined from a peak of 26.6% in 1985 to 16.4% in 1987, associated with an increase in the incidence of inborn admissions (including maternal transport) from 62.0% in 1984 to 80.4% in 1987. During initial hospitalization, the occurrence of both low-grade (Grades I and II) and high-grade PVH was associated with a significantly higher incidence of perinatal risk factors compared with a concurrent population of VLBW infants without PVH. Developmental follow-up was achieved in 93.3% of VLBW infants without PVH and 95.7% of VLBW infants with PVH who survived their initial hospitalization. The incidence of abnormal outcome ranged from 7 of 37 infants with Grade I PVH to 7 of 8 VLBW infants with Grade IV PVH. Only 1 of 16 VLBW infants with high-grade PVH demonstrated normal motor and cognitive development. Active hydrocephalus developed in 12 infants; 11 sustained a high-grade PVH. Appropriate treatment of intracranial hypertension did not modify the neurodevelopmental outcome. In conclusion, this regional population of VLBW infants demonstrated a decline in the incidence of PVH during the years 1984 to 1987 associated with an increase in the incidence of inborn admissions. The risk of abnormal neurodevelopmental outcome was elevated for all grades of PVH. A 12.0% incidence of hydrocephalus was associated with high-grade PVH, and appropriate treatment did not alter the poor prognosis.