Outcome of neonatal intraventricular hemorrhage with periventricular echodense lesions

Abstract

The incidence of periventricular‐intraventricular hemorrhage (PV‐IVH) in a group of 460 pretern infants with birth weight less than 2,250 gm, studies by cranial ultrasonography, was 39%. Sixty‐four (36%) of the infants with periventricular‐intravenmtricular hemorrhage had, in addition, perventricular intraparenchymal echodensity (IPE) evident on ultrasound scan. Thirty‐three of the 64 infants had large IPE, and 31 had small IPE. Large IPE consisted of globular echodensity, most often onj the side of maximum intraventricular hemorrhage, extending from the external angle of the laterakl ventricle into major portions of the white mater of the frontal and parietal lobes; small IPE, often bilateral, consisted of linear echodensity extending for a few millimeters from the external ange of the lateral ventricle into the periventricular white matter. The outcome for ingfants with large and a mall IPE differed markedly. Mortality was greatest(94%) for infants with large IPE and birth weight less thasn 1,000gm. All survivors with large IPE, regardless of birth weight, had modrate to severe neurological deficits evident on follow‐up. In contrast, infants with small IPE and birth weight, had moderate to severe neurological deficts evident on follow‐up. In contrast, infants with small IPE and birth weight less thasn 1,000 gm had a mortality of38%. Moreover, 70% of all survivors with small IPE were free of neurological deficits on follow‐up. The difference in outsome appeared to relate in largest part to the severity of the parenchymal involvement. Thjese data have major significance for decisions concerning management of infants with periventricular‐hemorrhage and intraparenchymal involvement.