Influence of gestational age on death and neurodevelopmental outcome in premature infants with severe intracranial hemorrhage
Influence of gestational age on death and neurodevelopmental outcome in premature infants with severe intracranial hemorrhage
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DOI：
10.1038/jp.2012.91
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发表时间：
2013-01-01
影响因子：
2.9
通讯作者：
Poole, W. K.
中科院分区：
文献类型：
--
作者：
Goldstein, R. F.;Cotten, C. M.;Poole, W. K.
目的：确定重度颅内出血后死亡和/或神经发育障碍（NDI）研究设计：人口统计学、围产期和新生儿因素对极低出生体重儿NDI的潜在影响（妊娠23 - 28周）;结局数据来自ELBW随访研究。NDI在18至22个月矫正年龄时定义为中度/重度脑瘫、贝利婴儿发育量表II认知或运动评分< 70和/或失明或耳聋。比较了与死亡或NDI相关的无或重度ICH的年龄较小婴儿与年龄较大婴儿的特征。结果：在6638名婴儿中，61.8%的婴儿无脑出血，13.6%的婴儿有严重脑出血，39%的婴儿有NDI。低GA组的死亡或NDI和死亡的风险调整比值较高。较低的GA增加了严重ICH婴儿30天内死亡的几率。坏死性小肠结肠炎（尤其是外科NEC）、迟发性感染、囊性脑室周围白质软化和出生后类固醇激素增加了死亡风险。在无ICH和3级ICH的婴儿中，GA的NDI不同，但4级ICH无差异。NDI的婴儿严重ICH的贡献者包括男性，手术NEC和出血后脑积水需要shunt.Conclusion：GA有助于ELBW婴儿的死亡风险，但NDI的幸存者严重ICH。男性、手术NEC和需要分流增加了NDI的额外风险。Journal of Perinatology（2013）33，25-32; doi：10.1038/jp.2012.91; 2012年7月19日在线发表
Objective: To determine whether death and/or neurodevelopmental impairment (NDI) after severe intracranial hemorrhage (ICH; grade 3 or 4) differs by gestational age (GA) at birth in extremely low birth weight (ELBW) infants.Study Design: Demographic, perinatal and neonatal factors potentially contributing to NDI for ELBW infants (23 to 28 weeks gestation) were obtained retrospectively; outcome data came from the ELBW Follow-up Study. NDI was defined at 18 to 22 months corrected age as moderate/severe cerebral palsy, Bayley Scales of Infant Development II cognitive or motor score < 70, and/or blindness or deafness. Characteristics of younger versus older infants with no versus severe ICH associated with death or NDI were compared. Generalized linear mixed models predicted death or NDI in each GA cohort.Result: Of the 6638 infants, 61.8% had no ICH and 13.6% had severe ICH; 39% of survivors had NDI. Risk-adjusted odds of death or NDI and death were higher in the lower GA group. Lower GA increased the odds of death before 30 days for infants with severe ICH. Necrotizing enterocolitis (particularly surgical NEC), late onset infection, cystic periventricular leukomalacia and post-natal steroids contributed to mortality risk. NDI differed by GA in infants without ICH and grade 3, but not grade 4 ICH. Contributors to NDI in infants with severe ICH included male gender, surgical NEC and post-hemorrhagic hydrocephalus requiring a shunt.Conclusion: GA contributes to the risk of death in ELBW infants, but not NDI among survivors with severe ICH. Male gender, surgical NEC and need for a shunt add additional risk for NDI. Journal of Perinatology (2013) 33, 25-32; doi:10.1038/jp.2012.91; published online 19 July 2012