The effects of premature birth-related subependymal and mild intraventricular hemorrhage (S/IVH) on specific cognitive abilities in 2-year-old children were investigated at the Perinatology Center, New York Hospital, and Cornell and New York University Medical Colleges. Of 82 children included in the study, 27 had premature births complicated by Grade I or II hemorrhages, 28 prematurely born children had normal neonatal ultrasound, and 27 were born at term without complications. The premature group with S/IVH at birth performed significantly less well than children without hemorrhage on a measure of memory for location and on ability to change response set. Both groups of prematurely born children performed less well than full term children on systematic search for an object when the order of hiding was reversed. All groups performed equally on a visual attention task and on the global Bayley mental ability scores. [1]

COMMENT. Prior testing of these prematures at age 10 months had shown that S/IVH affected global mental ability and habituation to visual patterns, and prematurity was associated with poorer memory for location. When reevaluated at 2 years, the premature groups with or without hemorrhage did not differ on the visual attention task, but prematures with S/IVH did poorly on the memory for location task and ability to change response set. Memory for location is a function of the caudate nucleus and thalamus and frontal cortex, areas affected by subependymal and intraventricular hemorrhage of prematurity. Fronto-striatal structural changes in the MRI have been demonstrated in patients with ADHD [2]. At a later age, the incidence of ADHD in the S/IVH affected children will be of interest.

Indomethacin prophylaxis against IVH in very low birth weight infants did not result in adverse cognitive or motor outcomes at 36 months, in a study at Yale University School of Medicine [3]. The authors suggest that the early administration of intravenous low-dose indomethacin to neonates weighing 1250 g or less is beneficial and does not cause neurodevelopmental delay. However, Dr Henrietta Bada, University of Tennessee, Memphis, advises caution, and slow infusion, because of reported acute cerebral effects. [4]