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

Stephanie Libzon; Shelly I Shiran; Aviva Fattal-Valevski; Nira Schneebaum-Sender; Jonathan Roth; Shlomi Constantini; Gustavo Malinger; Karina Krajden Haratz; Liat Ben Sira; Moran Hausman-Kedem

doi:10.1111/dmcn.16310

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

Dev Med Child Neurol. 2025 Mar 28. doi: 10.1111/dmcn.16310. Online ahead of print.

Authors

Stephanie Libzon^{1

2}, Shelly I Shiran^{3

4}, Aviva Fattal-Valevski^{1

4}, Nira Schneebaum-Sender^{1

4}, Jonathan Roth^{4

5}, Shlomi Constantini^{4

5}, Gustavo Malinger^{4

6}, Karina Krajden Haratz^{4

6}, Liat Ben Sira^{3

4}, Moran Hausman-Kedem^{1

4}

Affiliations

¹ Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.
² Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Department of Radiology, Division of Pediatric Radiology, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.
⁴ The Faculty of Medicine and Health Science, Tel Aviv University, Tel Aviv, Israel.
⁵ Pediatric Neurosurgery Department and the Pediatric Brain Center, Tel Aviv Medical Center, Tel Aviv, Israel.
⁶ Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.

PMID: 40156180
DOI: 10.1111/dmcn.16310

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.