Risk factors for adverse outcome in preterm infants with periventricular hemorrhagic infarction
Risk factors for adverse outcome in preterm infants with periventricular hemorrhagic infarction
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DOI：
10.1542/peds.2007-3305
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发表时间：
2008-07-01
期刊：
影响因子：
8
通讯作者：
Bos, Arend F.
中科院分区：
文献类型：
--
作者：
Roze, Elise;Kerstjens, Jorien M.;Bos, Arend F.
OBJECTIVE.我们的目的是确定与18个月时脑室周围出血性梗死早产儿死亡率和不良神经功能结局相关的危险因素。这是一项回顾性队列研究，对象是1995年至2006年间入院的所有妊娠< 37周、患有心室周围出血性梗死的早产儿。超声扫描检查了老年基质出血的分级、梗死的定位和范围以及其他异常。对几个临床因素进行评分。结局指标为死亡率、脑瘫和粗大运动功能分类系统水平。通过单因素和多因素logistic回归分析计算比值比。在54名婴儿中，16名（30%）死亡。38名幸存者中有25名（66%）发生脑瘫：21名轻度（粗大运动功能分类系统1级和2级），4名中度至重度（3级和4级）。围产期和新生儿的几个危险因素与死亡率有关。经多因素Logistic回归分析，仅使用正性肌力药物和母亲宫内感染是死亡率的预测因素。在幸存者中，只有最广泛的脑室周围出血性梗死与脑瘫的发展有关，但与脑瘫的严重程度无关。囊性脑室周围白质软化和并发3级老年基质出血与更严重的脑瘫相关。在脑室周围出血性梗死的早产儿中，尽管进行了最佳治疗，仍会发生死亡，并与循环衰竭和母体宫内感染相关。在幸存者中，66%的运动发育异常，但大多数功能能力良好。脑室周围出血性梗死的范围和位置与功能结局无关。
OBJECTIVE. Our objective was to identify risk factors that were associated with mortality and adverse neurologic outcome at 18 months of age in preterm infants with periventricular hemorrhagic infarction.METHODS. This was a retrospective cohort study of all preterm infants who were < 37 weeks' gestation, had periventricular hemorrhagic infarction, and were admitted between 1995 and 2006. Ultrasound scans were reviewed for grading of germinal matrix hemorrhage, localization and extension of the infarction, and other abnormalities. Several clinical factors were scored. Outcome measures were mortality, cerebral palsy, and Gross Motor Function Classification System level. Odds ratios were calculated by univariate and multivariate logistic regression analyses.RESULTS. Of 54 infants, 16 (30%) died. Twenty-five (66%) of 38 survivors developed cerebral palsy: 21 mild (Gross Motor Function Classification System levels 1 and 2) and 4 moderate to severe (levels 3 and 4). Several perinatal and neonatal risk factors were associated with mortality. After multivariate logistic regression, only use of inotropic drugs and maternal intrauterine infection were predictors of mortality. In survivors, only the most extended form of periventricular hemorrhagic infarction was associated with the development of cerebral palsy but not with severity of cerebral palsy. Cystic periventricular leukomalacia and concurrent grade 3 germinal matrix hemorrhage were associated with more severe cerebral palsy.CONCLUSIONS. In preterm infants with periventricular hemorrhagic infarction, mortality occurred despite optimal treatment and was associated with circulatory failure and maternal intrauterine infection. In survivors, motor development was abnormal in 66%, but functional abilities were good in the majority. Extension and localization of the periventricular hemorrhagic infarction were not related to functional outcome.