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Outcome of preterm infants with cerebral infarction “better than previously thought"

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Even though most surviving preterm infants with periventricular hemorrhagic infarction (PVHI) have cerebral palsy, results of a prospective cohort study indicate that functional motor outcome in childhood is only mildly affected, and mean IQ is just a few points lower than that of preterm infants without PVHI.

“PVHI is still considered a disastrous lesion and is sometimes associated with withdrawal of care,” Elise Roze and colleagues at the University of Groningen, The Netherlands, write in the June issue of Pediatrics. “Functional outcome at school age in preterm infants with PVHI, however, is still largely unknown.”

The researchers identified 21 survivors who were born at < 37 weeks’ gestation, had PVHI, and were admitted to their center between 1995 and 2003. Patients with major chromosomal and congenital anomalies were excluded.

The investigators assessed motor, cognitive, and behavioral outcomes when the subjects were 4 to 12 years of age (mean 8.7).

Results showed that 76% developed cerebral palsy, “but mostly with limited functional impairment.” Abilities most affected were coordination and balance, associated movements, and fine manipulation.

In 40% of the affected children, IQ was within one standard deviation of the mean of a normal control group, and total IQ was about 17 points below normal.

“However,” Roze and her associates note, “preterm infants with similar gestational age but without lesions are already known to have lower IQs… Therefore, if we take these children as the norm and compare our group to them, then 60% to 80% of the children would score within 1 SD of the mean.”

Verbal memory appeared to be most impaired, with 50% falling below the normal range, although recognition of memorized words was not impaired. Twelve children attended normal education classes, while two attended schools for children with physical impairment and seven went to schools for learning problems.

The researchers conclude: “Functional outcome at school age of preterm children with PVHI is better than previously reported.”

Reference:
Pediatrics 2009;123:1493-1500.