Neurodevelopmental Trajectories and Neurodevelopmental Disorders Following Neonatal Intracranial Hemorrhage: A Long-Term Follow-Up Study and Analysis of Influencing Factors

Abstract

Background: To investigate the neurodevelopmental trajectories, the incidence of neurodevelopmental disorders, and associated influencing factors in children following neonatal intracranial hemorrhage (ICH), thereby providing a reference for clinical intervention and prognostic improvement.

Methods: A total of 80 neonates diagnosed with ICH and admitted to the Neonatal Intensive Care Unit of the Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University were enrolled in this study. All participants completed long-term follow-up assessments over a period of 3–5 years. Baseline clinical data and imaging findings were collected. Neurodevelopmental outcomes were evaluated using the Gesell Developmental Schedules, and neurodevelopmental disorders were identified according to the diagnostic criteria for Brain Damage Syndrome (BDS). The characteristics of neurodevelopmental trajectories, the incidence of neurodevelopmental disorders, and relevant influencing factors were systematically analyzed.

Results: At the conclusion of follow-up, the proportion of children with neurodevelopmental abnormalities (defined as any Developmental Quotient [DQ] <85 on the Gesell Developmental Schedules) was 43.75%, while the incidence of neurodevelopmental disorders (defined according to the diagnostic criteria for BDS) was 38.75%. Gesell Developmental Schedule scores at the 1-, 3-, and 5-year follow-ups showed a gradual increase, with statistically significant differences between time points; the mean total scores were 72.36 ± 5.84, 81.57 ± 6.24, and 86.71 ± 5.93, respectively (F = 113.78, p < 0.001). Univariate analysis revealed that Papile grade of hemorrhage (p < 0.001), hemorrhage location (p < 0.001), birth weight (p < 0.001), gestational age (p < 0.001), perinatal asphyxia (p < 0.001), and concurrent hydrocephalus (p = 0.003) were significantly associated with neurodevelopmental disorders. Multivariate logistic regression identified parenchymal hemorrhage (odds ratio [OR] = 4.215, 95% confidence interval [CI]: 1.723–10.312, p = 0.002), Papile Grade IV (intraventricular hemorrhage with parenchymal hemorrhage) (OR = 3.826, 95% CI: 1.612–9.083, p = 0.003), birth weight < 2500 g (OR = 3.561, 95% CI: 1.458–8.697, p = 0.005), and perinatal asphyxia (OR = 3.294, 95% CI: 1.347–8.053, p = 0.009) as independent risk factors for the development of neurodevelopmental disorders following neonatal ICH.

Conclusions: Although neurodevelopmental outcomes exhibit gradual improvement following neonatal ICH, a substantial proportion of affected children continue to experience long-term neurodevelopmental abnormalities and disorders. Parenchymal hemorrhage, larger hemorrhage volume, low birth weight, and perinatal asphyxia are identified as key determinants influencing the occurrence of neurodevelopmental disorders. Early intervention strategies targeting these risk factors should be implemented in clinical practice to enhance long-term prognosis.