Intraventricular Hemorrhage and Neurodevelopmental Outcomes in Extreme Preterm Infants
Intraventricular Hemorrhage and Neurodevelopmental Outcomes in Extreme Preterm Infants
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DOI：
10.1542/peds.2013-0372
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发表时间：
2014-01-01
期刊：
影响因子：
8
通讯作者：
Lui, Kei
中科院分区：
文献类型：
--
作者：
Bolisetty, Srinivas;Dhawan, Anjali;Lui, Kei
目的：没有多少大型研究报道了早产儿低度脑室内出血的真正影响。我们研究了极早产儿的神经发育结果与脑室内出血严重程度的关系。方法：对1998年至2004年间出生在妊娠23至28周并入住NICU的婴儿进行区域队列研究。主要结局指标为矫正年龄2 - 3岁时的中度至重度神经感觉障碍，定义为发育迟缓（发育商>=低于平均值2个标准差）、脑瘫、双侧耳聋或双侧失明。结果：在评估的1472名幸存者中，患有III-IV级脑室内出血（IVH; n = 93）的婴儿发育迟缓（17.5%）、脑瘫（30%）、耳聋（8.6%）和失明（2.2%）的发生率较高。与没有IVH组（n = 1043）相比，I-II级IVH婴儿（n = 336）的神经感觉障碍（22%对12.1%）、发育迟缓（7.8%对3.4%）、脑瘫（10.4%对6.5%）和耳聋（6.0%对2.3%）的发生率也有所增加。在排除40例有晚期超声表现（脑室周围白质疏松症、脑孔畸形、脑室增大）的婴儿后，孤立的I-II级IVH （n = 296）的中重度神经感觉障碍发生率增加（18.6% vs 12.1%）。孤立的I-II级IVH也与较高的神经感觉障碍风险独立相关（校正优势比1.73,95%可信区间1.22-2.46）。结论：I-II级IVH，即使没有记录白质损伤或其他晚期超声异常，也与极早产儿的不良神经发育结局相关。
OBJECTIVE: Not many large studies have reported the true impact of lower-grade intraventricular hemorrhages in preterm infants. We studied the neurodevelopmental outcomes of extremely preterm infants in relation to the severity of intraventricular hemorrhage.METHODS: A regional cohort study of infants born at 23 to 28 weeks' gestation and admitted to a NICU between 1998 and 2004. Primary outcome measure was moderate to severe neurosensory impairment at 2 to 3 years' corrected age defined as developmental delay (developmental quotient >= 2 SD below the mean), cerebral palsy, bilateral deafness, or bilateral blindness.RESULTS: Of the 1472 survivors assessed, infants with grade III-IV intraventricular hemorrhage (IVH; n = 93) had higher rates of developmental delay (17.5%), cerebral palsy (30%), deafness (8.6%), and blindness (2.2%). Grade I-II IVH infants (n = 336) also had increased rates of neurosensory impairment (22% vs 12.1%), developmental delay (7.8% vs 3.4%), cerebral palsy (10.4% vs 6.5%), and deafness (6.0% vs 2.3%) compared with the no IVH group (n = 1043). After exclusion of 40 infants with late ultrasound findings (periventricular leukomalacia, porencephaly, ventricular enlargement), isolated grade I-II IVH (n = 296) had increased rates of moderate-severe neurosensory impairment (18.6% vs 12.1%). Isolated grade I-II IVH was also independently associated with a higher risk of neurosensory impairment (adjusted odds ratio 1.73, 95% confidence interval 1.22-2.46).CONCLUSIONS: Grade I-II IVH, even with no documented white matter injury or other late ultrasound abnormalities, is associated with adverse neurodevelopmental outcomes in extremely preterm infants.