Neurodevelopmental outcome of perinatal intracranial haemorrhage in patients born at term: A prospective study

Abstract

Aim: To assess the neurological and neurodevelopmental outcome of infants born at term with perinatal intracranial haemorrhage (pICH) and examine the clinical and neuroimaging associations. Method: A prospective, consecutive, single-center observational study of longitudinally followed children with pICH identified in the fetal or neonatal period (≤28 days of life) between January 2014 and November 2022. Neurodevelopmental outcome was rated using the Pediatric Stroke Outcome Measure (PSOM) and the modified Rankin Scale (mRS). Results: Sixty-eight infants were included (67.6% diagnosed postnatally and 32.4% diagnosed antenatally). Intraventricular haemorrhage was the most common bleeding type (n = 43, 63.2%) and was more common in infants diagnosed prenatally (p = 0.004). Twenty-nine (42.6%) infants were diagnosed with cerebral palsy and 19.1% with remote epilepsy. PSOM was performed at a median age of 3 years 8 months (range = 1 year–9 years 5 months). According to the PSOM, outcome was normal in 29 (42.6%) infants. Twelve (17.6%) patients had mild impairment, 11 (16.2%) had moderate impairment, and 16 (23.5%) had severe impairment. There was no difference in neurological outcomes between patients diagnosed antenatally or postnatally. Remote epilepsy (p = 0.002), multi-compartment ICH (p = 0.048), vermian hemorrhage (p = 0.048), posthaemorrhagic ventricular dilatation (p = 0.037), thalamic volume loss (p = 0.037), white matter loss (p = 0.048), Wallerian degeneration (p = 0.026), and abnormal myelination in the posterior limb of the internal capsule (p = 0.005), were associated with less favourable PSOM scores. Anterior horn width correlated with PSOM total scores (r = 0.6). Interpretation: pICH carries a significant risk of long-term adverse neurological outcomes with no difference in neurological outcome between those diagnosed antenatally or postnatally. Epilepsy and neuroradiological markers are associated with unfavourable neurodevelopmental outcomes.