Hemorrhage distribution, imaging-defined post-hemorrhagic ventricular dilatation, and clinical outcomes in neonates with intraventricular and cerebral parenchymal hemorrhage: a single-center retrospective cohort study
- 1Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- 2Department of Ultrasound, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- 3The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University (Hunan Children’s Hospital), Changsha, China
Abstract
Objective: Neonatal intracranial hemorrhage contributes substantially to neonatal mortality and neurodevelopmental impairment. This retrospective single-center cohort study aimed to investigate associations between hemorrhage anatomical distribution, post-haemorrhagic ventricular dilation severity, and clinical outcomes among neonates with intraventricular and/or cerebral parenchymal hemorrhage, and to identify factors associated with mortality and Neurodevelopmental abnormality.
Methods: This retrospective cohort study included 109 neonates with intraventricular hemorrhage (IVH) and/or cerebral parenchymal hemorrhage (CPH) hospitalized at Hunan Children's Hospital from 2015 to 2018. Patients were classified into isolated IVH, isolated CPH, and combined IVH with parenchymal involvement groups. Clinical characteristics, systemic comorbidities, PHVD severity, treatment interventions, and follow-up outcomes were analyzed. MRI findings were additionally evaluated in infants who underwent examination. Multivariable logistic regression was performed to identify factors associated with clinical outcomes.
Results: Among the 109 neonates, 44 (40.4%) had isolated IVH, 41 (37.6%) had isolated CPH, and 24 (22.0%) had combined IVH and parenchymal involvement. Imaging-defined post-hemorrhagic ventricular dilatation (PHVD) severity differed significantly among groups (P < 0.001), with moderate-to-severe imaging-defined PHVD occurring in 61.4%, 24.4%, and 70.8% of patients, respectively. Overall outcomes included 41 deaths (37.6%), 21 cases of Neurodevelopmental abnormality (19.3%), and 47 favorable outcomes (43.1%), with no significant difference among hemorrhage groups (P = 0.693). MRI provided additional identification of deep, posterior fossa, subarachnoid, and small focal hemorrhagic lesions. Lower gestational age and higher clinical severity scores were independently associated with mortality, whereas cerebrospinal fluid drainage or neurosurgical intervention was associated with lower odds of Neurodevelopmental abnormality (OR = 0.115, 95% CI: 0.022–0.595, P = 0.010). This observed association cannot be interpreted as causal or preventive therapeutic effect owing to inherent selection and survivorship bias in a retrospective observational study.
Conclusion: Hemorrhage distribution was associated with PHVD severity but not independently with mortality or Neurodevelopmental abnormality. Ventricular involvement identifies infants at higher risk of significant hydrocephalus, while gestational maturity and systemic disease burden remain important determinants of outcome. Ultrasound and MRI provide complementary information for clinical assessment. The observed association between cerebrospinal fluid-directed drainage or neurosurgical intervention and favourable neurological outcomes should be interpreted cautiously. Given the retrospective non-randomized nature of this cohort, causal inference regarding preventive benefit of these interventions is not feasible.
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BibTeX
@article{zhang2026hemorrhage,
title = {{Hemorrhage distribution, imaging-defined post-hemorrhagic ventricular dilatation, and clinical outcomes in neonates with intraventricular and cerebral parenchymal hemorrhage: a single-center retrospective cohort study}},
author = {Xuehua Zhang and Youchun Cai and Saifeng Huang and Huiqing Shi and Lingting Chen and Shuihua Wu and Yonghua Xiang},
journal = {Frontiers in Pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1965213},
url = {https://doi.org/10.3389/fped.2026.1965213},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Hemorrhage distribution, imaging-defined post-hemorrhagic ventricular dilatation, and clinical outcomes in neonates with intraventricular and cerebral parenchymal hemorrhage: a single-center retrospective cohort study
AU - Xuehua Zhang
AU - Youchun Cai
AU - Saifeng Huang
AU - Huiqing Shi
AU - Lingting Chen
AU - Shuihua Wu
AU - Yonghua Xiang
PY - 2026
DA - 2026/10/22
JO - Frontiers in Pediatrics
DO - 10.3389/fped.2026.1965213
UR - https://doi.org/10.3389/fped.2026.1965213
AB - Objective: Neonatal intracranial hemorrhage contributes substantially to neonatal mortality and neurodevelopmental impairment. This retrospective single-center cohort study aimed to investigate associations between hemorrhage anatomical distribution, post-haemorrhagic ventricular dilation severity, and clinical outcomes among neonates with intraventricular and/or cerebral parenchymal hemorrhage, and to identify factors associated with mortality and Neurodevelopmental abnormality. Methods: This retrospective cohort study included 109 neonates with intraventricular hemorrhage (IVH) and/or cerebral parenchymal hemorrhage (CPH) hospitalized at Hunan Children's Hospital from 2015 to 2018. Patients were classified into isolated IVH, isolated CPH, and combined IVH with parenchymal involvement groups. Clinical characteristics, systemic comorbidities, PHVD severity, treatment interventions, and follow-up outcomes were analyzed. MRI findings were additionally evaluated in infants who underwent examination. Multivariable logistic regression was performed to identify factors associated with clinical outcomes. Results: Among the 109 neonates, 44 (40.4%) had isolated IVH, 41 (37.6%) had isolated CPH, and 24 (22.0%) had combined IVH and parenchymal involvement. Imaging-defined post-hemorrhagic ventricular dilatation (PHVD) severity differed significantly among groups (P < 0.001), with moderate-to-severe imaging-defined PHVD occurring in 61.4%, 24.4%, and 70.8% of patients, respectively. Overall outcomes included 41 deaths (37.6%), 21 cases of Neurodevelopmental abnormality (19.3%), and 47 favorable outcomes (43.1%), with no significant difference among hemorrhage groups (P = 0.693). MRI provided additional identification of deep, posterior fossa, subarachnoid, and small focal hemorrhagic lesions. Lower gestational age and higher clinical severity scores were independently associated with mortality, whereas cerebrospinal fluid drainage or neurosurgical intervention was associated with lower odds of Neurodevelopmental abnormality (OR = 0.115, 95% CI: 0.022–0.595, P = 0.010). This observed association cannot be interpreted as causal or preventive therapeutic effect owing to inherent selection and survivorship bias in a retrospective observational study. Conclusion: Hemorrhage distribution was associated with PHVD severity but not independently with mortality or Neurodevelopmental abnormality. Ventricular involvement identifies infants at higher risk of significant hydrocephalus, while gestational maturity and systemic disease burden remain important determinants of outcome. Ultrasound and MRI provide complementary information for clinical assessment. The observed association between cerebrospinal fluid-directed drainage or neurosurgical intervention and favourable neurological outcomes should be interpreted cautiously. Given the retrospective non-randomized nature of this cohort, causal inference regarding preventive benefit of these interventions is not feasible.
SN - 2296-2360
ER -