NEW population data show how intraventricular hemorrhage shapes school performance in very preterm children, revealing clear differences by severity while also highlighting steady academic progress into adolescence for most survivors.
Why Intraventricular Hemorrhage Raises Long Term Concerns
Intraventricular hemorrhage is a common complication of very preterm birth, affecting around 20% of infants born before 32 weeks’ gestation. Advances in neonatal care have improved survival, shifting attention towards long term developmental outcomes. Clinicians and families have long questioned whether intraventricular hemorrhage independently affects learning beyond the risks of prematurity itself. Previous studies often focused on early childhood, leaving uncertainty about how children fare once they reach primary and secondary school, when academic demands become more complex and persistent difficulties may emerge.
School Outcomes After Intraventricular Hemorrhage
The population-based cohort study examined 408,189 children born in New South Wales, Australia, between 2007 and 2013. This included 557 children with low grade intraventricular hemorrhage, 85 with high grade intraventricular hemorrhage, 2557 very preterm controls without hemorrhage, and 404 990 full term controls. Academic performance was assessed using standardized national tests at ages 8 to 9, 10 to 11, and 12 to 13 years. Children with low grade intraventricular hemorrhage performed similarly to very preterm controls at all ages, with adjusted mean differences in overall academic z scores of −0.06, −0.09, and −0.04 respectively. However, children with grade 2 intraventricular hemorrhage showed poorer outcomes at age 8 to 9 years, with an adjusted mean difference of −0.20. High grade intraventricular hemorrhage was consistently associated with lower performance across all ages, including −0.50 at 8 to 9 years and −0.61 at 12 to 13 years. Numeracy was particularly affected, with an adjusted mean difference of −0.49 at age 8 to 9 years. Importantly, all groups demonstrated academic improvement over time, with parallel trajectories despite differing starting points.
Implications For Clinical Practice and Education
These findings suggest that intraventricular hemorrhage severity provides valuable prognostic information but should not be viewed deterministically. Most very preterm children, including those with high grade intraventricular hemorrhage, continue to make academic gains. For clinicians, this reinforces the importance of long term follow up, early identification of learning difficulties, and collaboration with educational services. Tailored academic support, particularly in numeracy, may help children reach their full potential.
Reference
Rees P et al. School performance of preterm-born children after intraventricular hemorrhage. JAMA Netw Open. 2025;8(12):e2547584.
