OUTCOME, COST-ANALYSIS, AND LONG-TERM FOLLOW-UP IN PRETERM INFANTS WITH MASSIVE GRADE-IV GERMINAL MATRIX HEMORRHAGE AND PROGRESSIVE HYDROCEPHALUS

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.