Murphy B P, Inder T E, Rooks V, Taylor G A, Anderson N J, Mogridge N, Horwood L J, Volpe J J
Division of Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Arch Dis Child Fetal Neonatal Ed. 2002 Jul;87(1):F37-41. doi: 10.1136/fn.87.1.f37.
To investigate the natural history and predictors of outcome of posthaemorrhagic ventriculomegaly in the very low birthweight (VLBW) infant.
All VLBW infants admitted between September 1994 and September 1997 to the neonatal intensive care units of Brigham and Women's Hospital (Boston), Children's Hospital (Boston), and Christchurch Women's Hospital (New Zealand) with germinal matrix intraventricular haemorrhage (IVH) were identified. All charts and ultrasound scans were reviewed to define the natural history and perinatal and/or postnatal factors of value in prediction of the course of posthaemorrhagic ventriculomegaly. Progressive ventricular dilatation (PVD) was defined from the results of serial cranial ultrasound scans.
A total of 248 VLBW infants had evidence of IVH (22% of all VLBW infants, mean (SD) gestational age 26.8 (2.6) weeks). A quarter of the infants exhibited PVD. Spontaneous arrest of PVD occurred without treatment in 38% of infants with PVD. Of the remaining 62% with persistent PVD, 48% received non-surgical treatment only (pharmacological and/or drainage of cerebrospinal fluid by serial lumbar punctures), 34% received surgical treatment with insertion of a ventriculoperitoneal reservoir and/or shunt, and 18% died. The development of PVD after IVH and adverse short term outcome, such as the requirement for surgery, were predicted most strongly by the severity of IVH.
These data reflect the natural history of PVD in the 1990s and show that, despite a slight reduction in its overall incidence, there appears to be a more aggressive course, with appreciable mortality and morbidity in the extremely premature infant. The major predictor of adverse short term outcome, defined as death or need for surgical intervention, was the severity of IVH. These findings may be valuable for the management of very small premature infants.
研究极低出生体重（VLBW）婴儿出血后脑室扩大的自然病史及预后预测因素。
确定1994年9月至1997年9月期间入住布里格姆妇女医院（波士顿）、儿童医院（波士顿）和克赖斯特彻奇妇女医院（新西兰）新生儿重症监护病房且患有生发基质脑室内出血（IVH）的所有VLBW婴儿。查阅所有病历和超声扫描结果，以确定出血后脑室扩大病程的自然病史以及围产期和/或产后有预测价值的因素。根据系列头颅超声扫描结果定义进行性脑室扩张（PVD）。
共有248例VLBW婴儿有IVH证据（占所有VLBW婴儿的22%，平均（标准差）胎龄26.8（2.6）周）。四分之一的婴儿出现PVD。38%的PVD婴儿未经治疗PVD自行停止。在其余62%持续存在PVD的婴儿中，48%仅接受非手术治疗（药物治疗和/或通过系列腰椎穿刺引流脑脊液），34%接受手术治疗，置入脑室腹腔分流管和/或分流器，18%死亡。IVH后PVD的发生及不良短期预后，如手术需求，最强的预测因素是IVH的严重程度。
这些数据反映了20世纪90年代PVD的自然病史，表明尽管其总体发病率略有下降，但病程似乎更具侵袭性，在极早产儿中有相当高的死亡率和发病率。不良短期预后（定义为死亡或需要手术干预）的主要预测因素是IVH的严重程度。这些发现可能对极早早产儿的管理有价值。
