Neurological outcomes in extremely preterm infants with periventricular hemorrhagic infarction: clinical and cranial ultrasound findings

Eur J Pediatr. 2026 Jul 6;185(7):553. doi: 10.1007/s00431-026-07216-7.

ABSTRACT

Periventricular hemorrhagic infarction (PVHI) is a severe complication of extreme prematurity associated with high mortality and neurodevelopmental impairment. We aimed to describe perinatal risk factors, ultrasonographic characteristics, mortality and neurodevelopment. Observational, longitudinal and prospective study of infants ≤ 28 weeks of gestational age born between 2018 and 2023. Perinatal clinical variables, cranial ultrasound findings, neurodevelopmental outcomes at 24 months of corrected age and mortality were collected. Multivariable logistic regression identified factors independently associated with PVHI, adverse outcomes and mortality. Among 168 infants, PVHI occurred in 25% (42/168) of them. Absent or incomplete antenatal corticosteroid exposure (OR 2.13; 95% CI 1.01-4.51) and advanced resuscitation at birth (OR 2.31; 95% CI 1.00-5.33) were independently associated with the PVHI. Larger infarcts (> 15 mm) and concomitant grade III GMH-IVH were associated with worse neurodevelopmental outcomes. Cerebral palsy was more common in infants with PVHI (30% (5/17) vs 7% (6/89), p = 0.015). However, posthemorrhagic ventriculomegaly was an independent predictor of cerebral palsy. The PVHI was an independent risk factor for death (OR 3.39; 95% CI 1.15-10.04; p = 0.027). Complete terminal vein involvement was independently associated with mortality (OR 18.9; 95% CI 1.47-243.13, p = 0.024).

CONCLUSIONS: PVHI remains a major complication of extreme prematurity. Antenatal corticosteroid appears protective. Larger infarcts (> 15 mm) and concomitant grade III GMH-IVH were associated with worse neurodevelopmental outcomes. The PVHI is an independent risk factor for mortality, whereas posthemorrhagic ventriculomegaly is an independent predictor of cerebral palsy.

WHAT IS KNOWN: • PVHI is a severe complication of extreme prematurity with high mortality and neurodevelopmental impairment. • The extent and anatomical location of PVHI are associated with motor impairment and mortality, but data in extremely preterm infants (≤ 28 weeks) are scarce.

WHAT IS NEW: • In infants ≤ 28 weeks, complete terminal vein involvement independently predicts mortality; posthemorrhagic ventriculomegaly, not PVHI, best predicts cerebral palsy. • Absent antenatal corticosteroids and advanced resuscitation are independently associated with PVHI.

PMID:42410045 | DOI:10.1007/s00431-026-07216-7