Ment L R, Vohr B, Allan W, Westerveld M, Katz K H, Schneider K C, Makuch R W
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
Pediatrics. 1999 Aug;104(2 Pt 1):243-8. doi: 10.1542/peds.104.2.243.
Despite improvements in survival data, the incidence of neurodevelopmental handicaps in preterm infants remains high. To prevent these handicaps, one must understand the pathophysiology behind them. For preterm infants, cerebral ventriculomegaly (VM) may be associated with adverse neurodevelopmental outcome. We hypothesized that although the causes of VM are multiple, the incidence of handicap at 4.5 years of age in preterm infants with this ultrasonographic finding at term would be high.
To test this hypothesis, we provided neurodevelopmental follow-up for all 440 very low birth weight survivors of the Multicenter Randomized Indomethacin Intraventricular Hemorrhage (IVH) Prevention Trial. A total of 384 children (87%) were evaluated at 54 months' corrected age (CA), and 257 subjects were living in English-speaking, monolingual households and are included in the following data analysis.
Moderate to severe low pressure VM at term was documented in 11 (4%) of the English-speaking, monolingual survivors. High grade IVH and bronchopulmonary dysplasia (BPD) were both risk factors for the development of VM. Of 11 (45%) children with VM, 5 suffered grades 3 to 4 IVH, compared with 2/246 (1%) children without VM who experienced grades 3 to 4 IVH. Similarly, 9/11 (82%) children with VM had BPD, compared with 120/246 (49%) children without VM who had BPD. Logistic regression analysis was performed using birth weight, gestational age, gender, Apgar score at 5 minutes, BPD, sepsis, moderate to severe VM, periventricular leukomalacia, grade of IVH, and maternal education to predict IQ <70. Although maternal education was an important and independent predictor of adverse cognitive outcome, in this series of very low birth weight prematurely born children, VM was the most important predictor of IQ <70 (OR: 19.0; 95% CI: 4.5, 80.6). Of children with VM, 6/11 (55%) had an IQ <70, compared with 31/246 (13%) of children without VM. Children with VM had significantly lower verbal and performance scores compared with children without VM.
These data suggest that, for preterm neonates, VM at term is a consequence of the vulnerability of the developing brain. Furthermore, its presence is an important and independent predictor of adverse cognitive and motor development at 4.5 years' CA.
尽管生存数据有所改善，但早产儿神经发育障碍的发生率仍然很高。为了预防这些障碍，必须了解其背后的病理生理学。对于早产儿来说，脑室扩大（VM）可能与不良神经发育结局有关。我们假设，尽管VM的病因多种多样，但足月时具有这种超声检查结果的早产儿在4.5岁时出现障碍的发生率会很高。
为了验证这一假设，我们对多中心随机吲哚美辛预防脑室内出血（IVH）试验的所有440名极低出生体重幸存者进行了神经发育随访。共有384名儿童（87%）在矫正年龄（CA）54个月时接受了评估，257名受试者生活在说英语的单语家庭中，并纳入以下数据分析。
在说英语的单语幸存者中，11名（4%）在足月时记录有中度至重度低压VM。重度IVH和支气管肺发育不良（BPD）都是VM发生的危险因素。在11名（45%）患有VM的儿童中，5名患有3至4级IVH，而在246名无VM的儿童中，只有2名（1%）经历了3至4级IVH。同样，11名患有VM的儿童中有9名（82%）患有BPD，而在246名无VM的儿童中有120名（49%）患有BPD。使用出生体重、胎龄、性别、5分钟时的阿氏评分、BPD、败血症、中度至重度VM、脑室周围白质软化、IVH分级和母亲教育程度进行逻辑回归分析，以预测智商<70。尽管母亲教育是不良认知结局的重要独立预测因素，但在这一系列极低出生体重的早产儿中，VM是智商<70的最重要预测因素（比值比：19.0；95%置信区间：4.5，80.6）。在患有VM的儿童中，11名中有6名（55%）智商<70，而在无VM的儿童中，246名中有31名（13%）智商<70。与无VM的儿童相比，患有VM的儿童的语言和操作得分显著更低。
这些数据表明，对于早产新生儿来说，足月时的VM是发育中大脑脆弱性的结果。此外，其存在是矫正年龄4.5岁时不良认知和运动发育的重要独立预测因素。
