Long-term neurodevelopmental outcomes and follow-up of germinal matrix-intraventricular hemorrhage in preterm infants

Germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) remains one of the most common neurological conditions in very preterm infants, with the incidence increasing with decreasing gestational age. GMH-IVH is associated with adverse neurodevelopmental outcomes and, for the purpose of prognostication, generally categorized into low-grade, i.e., grade 1 and 2 hemorrhage, and high-grade, i.e., grade 3 hemorrhage and periventricular hemorrhagic infarction. Prognosis, however, depends not only on the grade of GMH-IVH but also on co-occurring preterm brain injuries and downstream effects on brain maturation. In case of low-grade hemorrhage, outcomes are negatively affected by co-occurrence of white matter injury or cerebellar hemorrhage. High-grade hemorrhage, especially periventricular hemorrhagic infarction and when complicated by progressive post-hemorrhagic ventricular dilatation requiring neurosurgical intervention, is associated with a significantly higher likelihood of cognitive, motor, behavioral, and neurosensory impairments. Serial cranial ultrasound throughout the neonatal period is critically important to monitor the evolution of hemorrhage, its complications and overt other brain injury types. Brain MRI has additional value for detecting co-occurring subtle brain lesions and improving neuroprognostication. In this review, we summarize the neurodevelopmental outcomes across GMH-IVH grades and the influence of co-existing preterm brain injuries and secondary changes in brain maturation on outcomes. In addition, we recommend approaches to neurological and neurodevelopmental surveillance of preterm infants during neonatal intensive care admission and after discharge.