Intraventricular hemorrhage (IVH) revisited

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IVH remains one of the major morbidities of preterm birth at very low gestational ages. As with most complications of prematurity, incidences have decreased steadily over many years without a good understanding of the basic pathophysiology or targeted prevention treatment strategies. In the case of IVH, early use of indomethicin can reduce IVH, but many clinicians choose not to use this therapy. IVH also seems to be less lethal and neurodevelopmental outcomes may not be as uniformly bad as was reported in previous eras.

In this issue of The Journal, Brouwer et al report the natural history of post-hemorrhagic ventricular dilatation and neurodevelopmental outcomes for a large cohort of infants with Grade III and IV IVH. Post-hemorrhagic ventricular dilatation was more frequent following Grade III than Grade IV IVH, but cerebral palsy was much more frequent with Grand IV IVH. Overall, the mean developmental quotients at 2 years of age were surprisingly high: 99 for Grade III and 95 for Grade IV IVH. These outcomes are much better than generally considered for very preterm infants with severe IVH. In fact, the development quotients are higher than for populations of preterm infants without IVH. These surprising results need verification in other centers and other cohorts of preterm infants.

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