Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion
Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion
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DOI：
10.1542/peds.2007-0423
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发表时间：
2008-05-01
期刊：
影响因子：
8
通讯作者：
Higgins, Rose
中科院分区：
文献类型：
--
作者：
Adams-Chapman, Ira;Hansen, Nellie I.;Higgins, Rose
OBJECTIVE.我们的目的是评估与未插入分流管的婴儿相比，患有严重脑室内出血需要插入分流管的极低出生体重儿的神经发育和生长结局。1993-2002年出生的婴儿，出生体重为401至1000 g，在参加国家儿童健康和人类发育研究所新生儿研究网络的医疗中心的极低出生体重登记处登记，并在18至22个月的校正年龄返回进行随访。82%的幸存者完成了随访，6161名儿童被分为5组：第1组，无脑室内出血/无分流第2组，脑室内出血3级/无分流（n = 459）;第3组，脑室内出血3级/分流（n = 103）;组4，脑室内出血4级/无分流（n = 311）;组5，脑室内出血4级/分流（n = 125）。组间比较采用卡方检验和Wilcoxon检验进行评估，回归模型用于比较校正协变量后的结果。严重脑室内出血和分流的儿童与无脑室内出血的儿童和相同级别的脑室内出血和无分流的儿童相比，其Bayley婴儿发育量表IIR评分显著较低。接受分流术的婴儿在18个月校正年龄时脑瘫和头围<10百分位数的风险增加。在这些结果上，有分流术的儿童与没有脑室内出血的儿童之间的差异最大。这项大型队列研究表明，与有或无重度脑室内出血和无分流的儿童相比，极低出生体重且需要插入分流的重度脑室内出血儿童在18至22个月时发生不良神经发育和生长结局的风险最大。需要长期随访以确定不良结局是否持续或随时间推移而改善。
OBJECTIVE. We aimed to evaluate neurodevelopmental and growth outcomes among extremely low birth weight infants who had severe intraventricular hemorrhage that required shunt insertion compared with infants without shunt insertion.METHODS. Infants who were born in 1993-2002 with birth weights of 401 to 1000 g were enrolled in a very low birth weight registry at medical centers that participate in the National Institute of Child Health and Human Development Neonatal Research Network, and returned for follow-up at 18 to 22 months' corrected age were studied. Eighty-two percent of survivors completed follow-up, and 6161 children were classified into 5 groups: group 1, no intraventricular hemorrhage/no shunt (n = 5163); group 2, intraventricular hemorrhage grade 3/no shunt (n = 459); group 3, intraventricular hemorrhage grade 3/shunt (n = 103); group 4, intraventricular hemorrhage grade 4/no shunt (n = 311); and group 5, intraventricular hemorrhage grade 4/shunt (n = 125). Group comparisons were evaluated with chi(2) and Wilcoxon tests, and regression models were used to compare outcomes after adjustment for covariates.RESULTS. Children with severe intraventricular hemorrhage and shunts had significantly lower scores on the Bayley Scales of Infant Development IIR compared with children with no intraventricular hemorrhage and with children with intraventricular hemorrhage of the same grade and no shunt. Infants with shunts were at increased risk for cerebral palsy and head circumference at the < 10th percentile at 18 months' adjusted age. Greatest differences were observed between children with shunts and those with no intraventricular hemorrhage on these outcomes.CONCLUSIONS. This large cohort study suggests that extremely low birth weight children with severe intraventricular hemorrhage that requires shunt insertion are at greatest risk for adverse neurodevelopmental and growth outcomes at 18 to 22 months compared with children with and without severe intraventricular hemorrhage and with no shunt. Long-term follow-up is needed to determine whether adverse outcomes persist or improve over time.