Trends in Outcomes of Major Intracerebral Haemorrhage in a National Cohort of Very Preterm Born Infants in Switzerland

Philip Thwaites; Cornelia Hagmann; Juliane Schneider; Sven M Schulzke; Sebastian Grunt; Thi Dao Nguyen; Dirk Bassler; Giancarlo Natalucci; Swiss Neonatal Network and Follow-up Group

doi:10.3390/children10081412

Trends in Outcomes of Major Intracerebral Haemorrhage in a National Cohort of Very Preterm Born Infants in Switzerland

Children (Basel). 2023 Aug 19;10(8):1412. doi: 10.3390/children10081412.

Authors

Affiliations

¹ Newborn Research, Department of Neonatology, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland.
² Department of Paediatric and Neonatal Intensive Care, University Children's Hospital Zurich, CH-8032 Zurich, Switzerland.
³ Children's Research Center, University Children's Hospital Zurich, CH-8032 Zurich, Switzerland.
⁴ Woman-Mother-Child Department, Clinic of Neonatology, University Hospital Center, University of Lausanne, CH-1011 Lausanne, Switzerland.
⁵ Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, CH-4056 Basel, Switzerland.
⁶ Division of Neuropediatrics, Development and Rehabilitation, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, CH-3010 Bern, Switzerland.
⁷ Child Development Centre, University Children's Hospital Zurich, CH-8032 Zurich, Switzerland.
⁸ Family Larsson-Rosenquist Foundation Centre for Neurodevelopment, Growth and Nutrition of the Newborn, University Hospital Zurich, University of Zurich, CH-8091 Zurich, Switzerland.

Abstract

Background: Major brain lesions, such as grade 3 intraventricular haemorrhage (G3-IVH) and periventricular haemorrhagic infarction (PVHI) are among the main predictors for poor neurodevelopment in preterm infants. In the last decades advancements in neonatal care have led to a general decrease in adverse outcomes.

Aim: To assess trends of mortality and neurodevelopmental impairment (NDI) in a recent Swiss cohort of very preterm infants with grade 3 intraventricular haemorrhage (G3-IVH) and periventricular haemorrhagic infarction (PVHI).

Methods: In this retrospective population-based cohort study, rates of mortality, and NDI at 2 years corrected age were reported in infants born at 24-29 weeks gestational age (GA) in Switzerland in 2002-2014, with G3-IVH and/or PVHI.

Results: Out of 4956 eligible infants, 462 (9%) developed G3-IVH (n = 172) or PVHI (n = 290). The average mortality rates for the two pathologies were 33% (56/172) and 60% (175/290), respectively. In 2002-2014, no change in rates of mortality (G3-IVH, p = 0.845; PVHI, p = 0.386) or NDI in survivors (G3-IVH, p = 0.756; PVHI, p = 0.588) were observed, while mean GA decreased (G3-IVH, p = 0.020; PVHI, p = 0.004). Multivariable regression analysis showed a strong association of G3-IVH and PVHI for both mortality and NDI. Death occurred after withdrawal of care in 81% of cases.

Conclusion: In 2002-2014, rates of mortality and NDI in very preterm born infants with major brain lesions did not change. The significant decrease in mean GA and changing hospital policies over this time span may factor into the interpretation of these results.

Keywords: grade 3 intraventricular haemorrhage; major intraventricular haemorrhage; mortality; neurodevelopment; outcome; periventricular; periventricular haemorrhagic infarction; preterm infant.

Grants and funding

PZOOP3_161146/SNSF_/Swiss National Science Foundation/Switzerland