Influence of isolated low‐grade intracranial haemorrhages on the neurodevelopmental outcome of infants born very low birthweight

Aim To determine whether isolated low‐grade germinal matrix‐intraventricular haemorrhages (LG‐GMH‐IVH) and low‐grade punctate cerebellar haemorrhages (LG‐CBH) contribute to the neurodevelopment of infants born preterm with very low birthweight (VLBW). Method A prospective observational cohort study was conducted on infants born with VLBW hospitalized from January 2012 to July 2017 who had undergone serial cranial ultrasounds since birth and magnetic resonance susceptibility‐weighted imaging of the brain at term‐corrected age. Only those with VLBW carrying isolated LG‐GMH‐IVH (grades 1 or 2) or isolated LG‐CBH (punctate cerebellar haemorrhages ≤4 mm in diameter) or absence of lesions (no‐lesion) were enrolled and followed up to 3 years. The Griffiths Mental Development Scales, Extended and Revised version (GMDS‐ER), were used to assess neurodevelopment, considering unsatisfactory scores less than 85. Behaviour, according to the criteria of the International Classification of Diseases, 10th Revision, and rehabilitation data were noted. Results Two‐hundred and forty infants with VLBW were enrolled: 34 with LG‐GMH‐IVH, 17 with LG‐CBH, and 189 as no‐lesion. The LG‐GMH‐IVH and LG‐CBH groups scored worse than the no‐lesion group on all GMDS‐ER scores for 1 year, 2 years, and 3 years. The LG‐CBH group scored lower than the LG‐GMH‐IVH group for total GMDS‐ER scores at 1 year and 2 years but not at 3 years. At 3 years, compared with the LG‐CBH group, those with LG‐GMH‐IVH received less and later physical therapy, with more frequent attention problems. The odds ratio for unsatisfactory GMDS‐ER scores corrected for gestational age was 5.75 for LG‐CBH (95% confidence interval 1.92–17.25; p = 0.002) and 2.67 for LG‐GMH‐IVH (95% confidence interval 1.16–6.13; p = 0.02). Interpretation Low‐grade haemorrhages affect the neurodevelopment of very‐low‐birthweight infants. Early rehabilitation might have contributed to their development. What this paper adds Low‐grade haemorrhages seem to have an independent role in the adverse neurodevelopment of infants born extremely preterm. Infants born preterm with low‐grade germinal matrix‐intraventricular haemorrhage (LG‐GMH‐IVH) are indicated for physical therapy at a later age than those with low‐grade punctate cerebellar haemorrhage (LG‐CBH). Compared with LG‐CBH, LG‐GMH‐IVH is associated with a greater extent of attention problems at 3 years corrected age. What this paper adds Low‐grade haemorrhages seem to have an independent role