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

The aim of this work is to prospectively study the neurological and neurodevelopmental outcome of term-born patients with perinatal intracranial hemorrhage (pICH) and identify predictive clinical and neuroimaging factors.

a prospective, consecutive single-center cohort of longitudinally followed children with pICH identified in the fetal or neonatal period (≤ 28 days of life) between 2014- November 2022. Neurodevelopmental outcome was rated using the Pediatric Stroke Outcome Measure (PSOM) and the modified-Rankin scale (mRS).  

Sixty-eight consecutive subjects were included (67.6%- diagnosed postnatally and 32.4% diagnosed antenatally). Intraventricular hemorrhage (IVH) was the most common bleeding type (n=43, 63.2%) and was more common in patients diagnosed prenatally (p=0.004). Twenty-nine (42.6%) patients were diagnosed with cerebral palsy and 19.1% with remote epilepsy. PSOM was performed at a median age of 3.8 (range 1-9.6 years). According to PSOM, outcome was normal in 32 (47.1%) subjects. Nine (13.2%) had mild impairment, 11 (16.2%) had moderate impairment and 16 (23.5%) had severe impairment. There was no difference in neurological outcome between patients diagnosed antenatally and those diagnosed postnatally. Remote epilepsy (p0.001), multicompartment ICH (p=0.016), post hemorrhagic ventricular dilatation (PHVD) (p=0.020), thalamus and vermian hemorrhage (p=0.014), white matter loss (p=0.0029), Wallerian degeneration (p=0.007), abnormal myelination in the posterior limb of internal capsule (p=0.01), were associated with less favorable PSOM scores. Anterior horn width correlated with PSOM total scores (r=0.6).

pICH in patients born at term carries a significant risk of long-term adverse neurological outcomes with no difference in neurological outcome between those diagnosed antenatally or postnatally. Epilepsy as well as neuroradiological markers predicted unfavorable neurodevelopmental outcomes. 

The study highlights the importance of individualized early intervention physiotherapy programs for children with pICH, tailored to their unique neurological conditions, including cerebral palsy and epilepsy. Specific clinical and imaging markers associated with unfavorable outcomes can help guide risk stratification and personalize care plans, enabling healthcare providers to prioritize and intensify rehabilitation for high-risk patients.