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Infants who survive periventricular hemorrhagic infarction commonly develop significant cognitive or motor abnormalities. Infants who survive periventricular hemorrhagic infarction commonly develop significant cognitive or motor abnormalities, according to a report in the October issue of Pediatrics.

"Although periventricular hemorrhagic infarction commonly results in abnormal neurodevelopmental outcome, 30 per cent of survivors nevertheless have a more favorable outcome and almost two thirds have relatively preserved adaptive measures," Dr. Haim Bassan told Reuters Health.

"We speculate that these findings may reflect factors such as advances in modern neonatal intensive care and the advantages of early intervention, among others."

Dr. Bassan and colleagues at Children's Hospital in Boston investigated the neurodevelopmental and adaptive outcomes of 30 periventricular hemorrhagic infarction survivors and sought to identify early cranial ultrasound predictors of adverse outcome. Adjusted age at evaluation ranged from 12 to 66 months.

Just over half of the infants (55 per cent) had either visual acuity or visual field abnormalities, the authors report, and nearly three quarters (73 per cent) experienced delays in gross motor function.

Half the children showed significantly diminished cognitive skills, and one third showed impairment in daily living skills.

Twenty-one of the 29 survivors with complete follow-up data had either abnormal neurological examination or low cognition scores, the researchers note.

Left-sided periventricular hemorrhagic infarction, which tended to be more extensive than right-sided periventricular hemorrhagic infarction, was associated with abnormal tone and with ventriculoperitoneal shunt insertion, the investigators report.

"Periventricular hemorrhagic infarction involving the anterior frontal and posterior frontal territories was associated with abnormal scores of visual-receptive domain and fine-motor domain, abnormal neurological examination, and hypertonia."

The extent of echodensity and midline shift were associated with gross motor development, visual-receptive scores, abnormal neuromotor examination, and hypertonia, the report indicates, whereas the extent of echogenicity was associated with fine motor development.

"I use the cranial ultrasound-periventricular hemorrhagic infarction severity score to improve prognostic accuracy whenever we encounter an infant with periventricular hemorrhagic infarction in our NICU," Dr. Bassan explained.

"I provide this valuable clinical information both to the parents...and to the neonatologists at the NICU. I believe that this score is another small yet potentially important piece in the puzzle of acute life support decision-making at the very early period when the baby with periventricular hemorrhagic infarction is critically ill. Additionally, our score could assist in early intervention developmental strategies upon discharge from the NICU."

"We plan to study the long-term neuroanatomical-structural outcome in periventricular hemorrhagic infarction survivors using advanced MRI techniques," Dr. Bassan added. "By this way we can learn more about the mechanisms of brain injury in these infants and look at imaging-based predictors of outcome."

Pediatrics 2007;120:785-792.