Patra Kousiki, Wilson-Costello Deanne, Taylor H Gerry, Mercuri-Minich Nori, Hack Maureen
Department of Pediatrics at Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio 44106, USA.
J Pediatr. 2006 Aug;149(2):169-73. doi: 10.1016/j.jpeds.2006.04.002.
To quantify the effect of grades I-II intraventricular hemorrhage (IVH) on the neurosensory and cognitive outcomes of extremely low birth weight infants.
Of 706 extremely low birth weight infants without major malformations admitted to our center from 1992 to 2000, 537 survived to 20 months' corrected age (CA) and had cranial ultrasound studies performed, of whom 490 (91%) had complete neurodevelopmental assessments. Infants with severe cranial ultrasound abnormalities or meningitis were excluded, leaving a population of 362 infants, 258 of whom had a normal cranial ultrasound and 104 had an isolated grade I-II IVH. The groups had similar birth weight (808 vs 801 grams) and gestational age (26.5 vs 26.3 weeks). Outcomes of infants with normal cranial ultrasound were compared with those with grades I-II IVH at 20 months' CA. Outcomes included the Bayley Scales of Infant Development Mental Developmental Index (MDI) and major neurosensory abnormality. Logistic regression was used to assess the effect of grades I-II IVH on outcomes while adjusting for other risk factors.
Extremely low birth weight infants with grades I-II IVH had a significantly lower mean MDI score than infants with normal cranial ultrasound (74 +/- 16 vs 79 +/- 14, P = .006). They had higher rates of MDI <<70 (45% vs 25%; OR, 2.00; 95% CI, 1.20 to 3.30; P = .008), major neurologic abnormality (13% vs 5%; OR, 2.60; 95% CI, 1.06 to 6.36; P = .036), and neurodevelopmental impairment (47% vs 28%; OR, 1.83; 95% CI, 1.11 to 3.03; P = .018) at 20 months' CA, even when adjusting for confounding factors.
Extremely low birth weight infants with grades I-II IVH have poorer neurodevelopmental outcomes at 20 months' CA than infants with normal cranial ultrasound. Advanced radiologic imaging may indicate additional brain injury associated with grade I-II IVH, which could explain these outcomes.
量化I-II级脑室内出血（IVH）对极低出生体重儿神经感觉和认知结局的影响。
1992年至2000年期间，我院收治的706例无严重畸形的极低出生体重儿中，537例存活至矫正年龄（CA）20个月，并接受了头颅超声检查，其中490例（91%）进行了完整的神经发育评估。排除头颅超声严重异常或患有脑膜炎的婴儿后，剩余362例婴儿，其中258例头颅超声正常，104例为单纯I-II级IVH。两组婴儿的出生体重（808 vs 801克）和胎龄（26.5 vs 26.3周）相似。将头颅超声正常的婴儿与矫正年龄20个月时患有I-II级IVH的婴儿的结局进行比较。结局指标包括贝利婴儿发育量表心理发育指数（MDI）和主要神经感觉异常。采用逻辑回归分析评估I-II级IVH对结局的影响，并对其他危险因素进行校正。
矫正年龄20个月时，患有I-II级IVH的极低出生体重儿的平均MDI得分显著低于头颅超声正常的婴儿（74±16 vs 79±14，P = 0.006）。他们的MDI<<70的发生率更高（45% vs 25%；OR，2.00；95%CI，1.20至3.30；P = 0.008），主要神经异常的发生率更高（13% vs 5%；OR，2.60；95%CI，1.06至6.36；P = 0.036），神经发育受损的发生率更高（47% vs 28%；OR，1.83；95%CI，1.11至3.03；P = 0.018），即使校正了混杂因素。
矫正年龄20个月时，患有I-II级IVH的极低出生体重儿的神经发育结局比头颅超声正常的婴儿更差。先进的影像学检查可能显示与I-II级IVH相关的额外脑损伤，这可以解释这些结局。
