Neurodevelopmental outcome in survivors of periventricular hemorrhagic infarction
Neurodevelopmental outcome in survivors of periventricular hemorrhagic infarction
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DOI：
10.1542/peds.2007-0211
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发表时间：
2007-10-01
期刊：
影响因子：
8
通讯作者：
du Plessis, Adre J.
中科院分区：
文献类型：
--
作者：
Bassan, Haim;Limperopoulos, Catherine;du Plessis, Adre J.
目标。脑室周围出血性脑梗塞是早产儿生发基质脑室内出血的严重并发症。我们的目的是确定脑室周围出血性脑梗塞幸存者的神经发育和适应性结果，并确定不良结果的早期头颅超声预测因素。方法：我们回顾评估了30例脑室周围出血性脑梗塞的早产儿的所有头颅超声，并根据脑室周围出血性脑梗塞(1)是否累及2个区域，(2)是否双侧，或(3)是否引起中线移位，给出了基于颅脑超声的脑室周围出血性脑梗塞严重程度评分(范围：0-3)。然后，我们进行神经运动、视觉功能和发育评估(马伦早期学习量表、Vineland适应行为量表)。结果：评估时调整的中位年龄为30个月(范围：12-66个月)。18例(60%)有肌张力异常，7例(26%)有视野缺陷。发育迟缓涉及粗大运动(22[73%])、精细运动(17[59%])、视觉感受(13[46%])、表达语言(11[38%])和认知(14[50%])领域。有10名(33%)和6名(20%)婴儿的日常生活和社交能力受损。基于头颅超声的脑室周围出血性脑梗塞严重程度评分较高可预测小头畸形和粗大运动、视觉接受和认知功能的异常。结论：在当前时代，三分之二的脑室周围出血性脑梗塞幸存者发展为显著的认知和/或运动异常，而适应技能相对较少。较高的基于颅脑超声的脑室周围出血性脑梗塞严重程度评分在几种情况下预测更差的结果，并可能被证明是一种有价值的预测工具。
OBJECTIVES. Periventricular hemorrhagic infarction is a serious complication of germinal matrix-intraventricular hemorrhage in premature infants. Our objective was to determine the neurodevelopmental and adaptive outcomes of periventricular hemorrhagic infarction survivors and identify early cranial ultrasound predictors of adverse outcome.METHODS. We retrospectively evaluated all cranial ultrasounds of 30 premature infants with periventricular hemorrhagic infarction and assigned a cranial ultrasound-based periventricular hemorrhagic infarction severity score (range: 0-3) on the basis of whether periventricular hemorrhagic infarction (1) involved >= 2 territories, (2) was bilateral, or (3) caused midline shift. We then performed neuromotor, visual function, and developmental evaluations (Mullen Scales of Early Learning, Vineland Adaptive Behavior Scale). Developmental scores below 2 SD from the mean were defined as abnormal.RESULTS. Median adjusted age at evaluation was 30 months (range: 12-66 months). Eighteen subjects (60%) had abnormal muscle tone, and 7 (26%) had visual field defects. Developmental delays involved gross motor (22 [73%]), fine motor (17 [59%]), visual receptive (13 [46%]), expressive language (11 [38%]), and cognitive (14 [50%]) domains. Impairment in daily living and socialization was documented in 10 (33%) and 6 (20%) infants, respectively. Higher cranial ultrasound based periventricular hemorrhagic infarction severity scores predicted microcephaly and abnormalities in gross motor, visual receptive, and cognitive function.CONCLUSIONS. In the current era, two thirds of periventricular hemorrhagic infarction survivors develop significant cognitive and/or motor abnormalities, whereas adaptive skills are relatively spared. Higher cranial ultrasound-based periventricular hemorrhagic infarction severity scores predict worse outcome in several modalities and may prove to be a valuable tool for prognostication.