Influence of gestational age on death and neurodevelopmental outcome in premature infants with severe intracranial hemorrhage

R. F. Goldstein, C. M. Cotten, S. Shankaran, M. G. Gantz, W. K. Poole

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Objective:To determine whether death and/or neurodevelopmental impairment (NDI) after severe intracranial hemorrhage (ICH; grade 3 or 4) differs by gestational age (GA) at birth in extremely low birth weight (ELBW) infants.Study Design:Demographic, perinatal and neonatal factors potentially contributing to NDI for ELBW infants (23 to 28 weeks gestation) were obtained retrospectively; outcome data came from the ELBW Follow-up Study. NDI was defined at 18 to 22 months corrected age as moderate/severe cerebral palsy, Bayley Scales of Infant Development II cognitive or motor score <70, and/or blindness or deafness. Characteristics of younger versus older infants with no versus severe ICH associated with death or NDI were compared. Generalized linear mixed models predicted death or NDI in each GA cohort.Result:Of the 6638 infants, 61.8% had no ICH and 13.6% had severe ICH; 39% of survivors had NDI. Risk-adjusted odds of death or NDI and death were higher in the lower GA group. Lower GA increased the odds of death before 30 days for infants with severe ICH. Necrotizing enterocolitis (particularly surgical NEC), late onset infection, cystic periventricular leukomalacia and post-natal steroids contributed to mortality risk. NDI differed by GA in infants without ICH and grade 3, but not grade 4 ICH. Contributors to NDI in infants with severe ICH included male gender, surgical NEC and post-hemorrhagic hydrocephalus requiring a shunt.Conclusion:GA contributes to the risk of death in ELBW infants, but not NDI among survivors with severe ICH. Male gender, surgical NEC and need for a shunt add additional risk for NDI.

Original languageEnglish
Pages (from-to)25-32
Number of pages8
JournalJournal of Perinatology
Issue number1
StatePublished - Jan 2013

Bibliographical note

Funding Information:
The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) provided grant support for the Neonatal Research Network’s Generic Database and Follow-up Studies. Data collected at participating sites of the NICHD Neonatal Research Network (NRN) were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed and analyzed the data for this study. On behalf of the NRN, Dr Abhik Das (DCC Principal Investigator) and Mr Douglas Kendrick (DCC Statistician) had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following investigators, in addition to those listed as authors, participated in this study: NRN Chair: Alan H Jobe, MD, PhD, University of Cincinnati. Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island (U10 HD27904)FWilliam Oh, MD; Abbot R Laptook, MD; Betty R Vohr, MD; Barbara Alksninis, PNP; Angelita M Hensman, RN, BSN; Teresa M Leach, MEd, CAES; Martha R Leonard, BA, BS; Lucy Noel; Rachel A Vogt, MD; Victoria E Watson, MS, CAS. Case Western Reserve University Rainbow Babies & Children’s Hospital (GCRC M01 RR80, U10 HD21364)FMichele C Walsh, MD, MS; Avroy A Fanaroff, MD; Nancy S Newman, RN; Bonnie S Siner, RN; Harriet G Friedman, MA. Cincinnati Children’s Hospital Medical Center University of Cincinnati Hospital and Good Samaritan Hospital (GCRC M01 RR8084, U10 HD27853)FEdward F Donovan, MD; Jean J Steichen, MD; Barbara Alexander, RN; Cathy Grisby, BSN, CCRC; Marcia Worley Mersmann, RN; Holly L Mincey, RN, BSN; Jody Hessling, RN; Teresa L Gratton, PA. Duke University School of Medicine University Hospital, Alamance Regional Medical Center, and Durham Regional Hospital (GCRC M01 RR30, U10 HD40492)FRonald N Goldberg, MD; Kathy J Auten, MSHS; Kathryn E Gustafson, PhD; Melody B Lohmeyer, RN, MSN. Emory University Children’s Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown (GCRC M01 RR39, U10 HD27851)FBarbara J Stoll, MD; Ira Adams-Chapman, MD; Sheena Carter, PhD; Elisabeth Dinkins, PNP; Ellen C Hale, RN, BS, CCRC; Maureen Mulligan LaRossa, RN; Gloria V Smikle, PNP, MSN. Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentFLinda L Wright, MD; Elizabeth M McClure, MEd. Indiana University Indiana University Hospital, Methodist Hospital, Riley Hospital for Children and Wishard Health Services (GCRC M01 RR750, U10 HD27856)FBrenda B Poindexter, MD, MS; James A Lemons, MD; Marilyn Bull, MD; Anna M Dusick, MD, FAAP; Darlene Kardatzke, MD; Carolyn Lytle, MD, MPH; Diana D Appel, RN, BSN; Lon G Bohnke, MS; Greg Eaken, PhD; Dianne E Herron, RN; Lucy C Miller, RN, BSN, CCRC; Heike M Minnich, PsyD, HSPP; Leslie Richard, RN; Leslie Dawn Wilson, BSN, CCRC. RTI International (U01 HD36790)FAbhik Das, PhD; W Kenneth Poole, PhD; Betty Hastings; Elizabeth M McClure, MEd; Jeanette O’Donnell Auman, BS; Carolyn M Petrie Huitema, MS; Scott E Schaefer, MS. Stanford University Lucile Packard Children’s Hospital and California Pacific Medical Center (GCRC M01 RR70, U10 HD27880)FDavid K Stevenson, MD; Krisa P Van Meurs, MD; Charles E Ahlfors, MD; Jean G Kohn, MD, MPH; Dharshi Sivakumar, MD, MRCP; M Bethany Ball, BS, CCRC; Robert D Stebbins, MD; Carol G Kuelper, PhD; Julie C Lee-Ancajas, PhD; Joan M Baran, PhD; Lori E Bond, PhD; Ginger K Brudos, PhD; Anne M DeBattista, RN, PNP; Renee P Pyle, PhD; Nicholas H St John, PhD. University of Alabama at Birmingham Health System and Children’s Hospital of Alabama (GCRC M01 RR32, U10 HD34216)FWaldemar A Carlo, MD; Myriam Peralta-Carcelen, MD, MPH; Kathleen G Nelson, MD; Kirstin J Bailey, PhD; Fred J Biasini, PhD; Stephanie A Chopko, PhD; Monica V Collins, RN, BSN MaEd; Shirley S Cosby, RN, BSN; Mary Beth Moses, PT, MS, PCS; Vivien A Phillips, RN, BSN; Julie Preskitt, MSOT, MPH; Richard V Rector, PhD; Sally Whitley, MA, OTR-L, FAOTA. University of CaliforniaFSan Diego Medical Center and Sharp Mary Birch Hospital for Women and Newborns (U10 HD40461)FNeil N Finer, MD; Yvonne E Vaucher, MD, MPH; Maynard R Rasmussen MD; Paul R Wozniak, MD; Kathy Arnell, RNC; Renee Bridge, RN; Clarence Demetrio, RN; Martha G Fuller, RN, MSN; Donna Posin, OTR/L, MPA; Wade Rich, BSHS, RRT. University of Miami Holtz Children’s Hospital (GCRC M01 RR16587, U10 HD21397)FShahnaz Duara, MD; Charles R Bauer, MD; Mary Allison, RN; Ruth Everett-Thomas, RN, MSN; Alexis N Diaz, BA; Elaine O Mathews, RN; Kasey Hamlin-Smith, PhD; Lisa Jean-Gilles, BA; Maria Calejo, MS; Silvia M Frade Eguaras, BA; Silvia Hiriart-Fajardo, MD; Yamiley C Gideon, BA. University of New Mexico Health Sciences Center (GCRC M01 RR997, U10 HD27881)FLu-Ann Papile, MD; Conra Backstrom Lacy, RN; Jean R Lowe, PhD. University of Rochester Golisano Children’s Hospital, University of Rochester Medical Center (U10 HD40521, GCRC M01 RR44)FDale L Phelps, MD; Gary Myers, MD; Erica Burnell, RN; Mary Rowan, RN; Julie Babish Johnson, MSW; Diane Hust, RN, PNP; Rosemary L Jensen; Emily Kushner, MA; Joan Merzbach, LMSW; Linda Reubens, RN; Lauren Zwetsch, RN, MS, PNP. University of Tennessee (U10 HD21415)FSheldon B Korones, MD; Henrietta S Bada, MD; Tina Hudson, RN, BSN; Marilyn Williams, LCSW; Kimberly Yolton, PhD. University of Texas Southwestern Medical Center at Dallas Parkland Health & Hospital System and Children’s Medical Center Dallas (GCRC M01 RR633, U10 HD40689)FAbbot R Laptook, MD; Charles R Rosenfeld, MD; Walid A Salhab, MD; R Sue Broyles, MD; Roy J Heyne, MD; Sally S Adams, PNP; Cathy Twell Boatman, MS; Cristin Dooley, PhD, LSSP; Alicia Guzman; Elizabeth Heyne, PA-C; Jackie F Hickman, RN; Linda A Madden, BSN, RN, CPNP; Nancy A Miller, RN; Janet S Morgan, RN; Susie Madison, RN; Gaynelle Hensley, RN. University of Texas Health Science Center at Houston Medical School, Children’s Memorial Hermann Hospital, and Lyndon B Johnson General Hospital (U10 HD21373)FKathleen Kennedy, MD, MPH; Jon E Tyson, MD, MPH; Pamela J Bradt, MD, MPH; Terri Major-Kincade, MD, MPH; Brenda H Morris, MD; Laura L Whitely, MD; Esther G Akpa, RN, BSN; Nora I Alaniz, BS; Magda Cedillo; Patty A Cluff, RN; Susan Dieterich, PhD; Claudia I Franco, RNC, MSN; Anna E Lis, RN, BSN; Georgia E McDavid, RN; Patti L Pierce Tate, RCP. Wake Forest University Baptist Medical Center, Forsyth Medical Center, and Brenner Children’s Hospital (GCRC M01 RR7122, U10 HD40498)FT Michael O’Shea, MD, MPH; Robert G Dillard, MD; Nancy J Peters, RN, CCRP; Korinne Chiu, MA; Deborah Evans Allred, MA, LPA; Donald J Goldstein, PhD; Raquel Halfond, MA; Barbara G Jackson, RN, BSN; Carroll Peterson, MA; Ellen L Waldrep, MS; Melissa Whalen Morris, MA; Gail Wiley Hounshell, PhD. Wayne State University Hutzel Women’s Hospital and Children’s Hospital of Michigan (U10 HD21385)FYvette R Johnson, MD; Rebecca Bara, RN, BSN; Debra Driscoll, RN, BSN; Laura Goldston, MA; Deborah Kennedy, RN, BSN; Geraldine Muran, RN, BSN. Yale University Yale-New Haven Children’s Hospital (GCRC M01 RR6022, U10 HD27871)FRichard A Ehrenkranz, MD; Patricia Gettner, RN; Nancy Close, PhD; Walter Gilliam, PhD; Monica Konstantino, RN, BSN; JoAnn Poulsen, RN; Elaine Romano, MSN; Janet Taft, RN, BSN; Joanne Williams, RN, BSN.


  • death
  • extremely low birth weight
  • infant
  • neurodevelopmental impairment
  • premature

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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