Hj. Pikus et al., OUTCOME, COST-ANALYSIS, AND LONG-TERM FOLLOW-UP IN PRETERM INFANTS WITH MASSIVE GRADE-IV GERMINAL MATRIX HEMORRHAGE AND PROGRESSIVE HYDROCEPHALUS, Neurosurgery, 40(5), 1997, pp. 983-988
OBJECTIVE: The benefit of aggressive management and surgical intervent
ion in preterm infants with massive Grade IV intracranial hemorrhage h
as been questioned based on the poor outcome of this group of patients
despite such therapy. To further delineate this problem, we reviewed
the records of premature neonates in this category as to outcome and i
nitial hospital cost. METHODS: We performed a retrospective review of
the medical records at our institution from 1977 to 1987 to identify p
remature neonates who had sustained massive hemorrhagic infarction of
one hemisphere in addition to having blood in both ventricles and prog
ressive hydrocephalus. RESULTS: During the study, a total of 52 such p
atients were identified, only 19 (6 female and 13 male patients) of wh
om survived. Intellectual function was observed to be greater than 2 s
tandard deviations below the mean in 15 of the 19 patients, between 1
and 2 standard deviations below the mean in 1 of 19, and 1 standard de
viation below the mean in 3 of 19. Motor function was as follows: 12 o
f 19 had marked spastic quadriparesis, 2 of 19 had moderate spastic qu
adriparesis, 3 of 19 had spastic hemiplegia, 1 of 19 had spastic diple
gia, and 1 of 19 had mild spastic hemiparesis. Eleven of 19 had chroni
c seizure disorders. The first hospitalization cost for the group of p
atients exceeded, on the average, $150,000 per patient for the 19 long
-term survivors. CONCLUSION: As we have previously reported, logistic
regression analysis determined that grade of hemorrhage was the only s
ignificant predictor of cognitive and motor outcomes. Most premature n
eonates with massive intracranial hemorrhages do not survive. The outc
omes in those who do is very poor and the cost so high that we suggest
that until therapeutic intervention exhibits efficacy, the considerat
ion of withdrawal of life support should be presented as an option to
the parents of these unfortunate children.