Vassilyadi Michael, Tataryn Zachary, Shamji Mohammed F, Ventureyra Enrique C G
Division of Neurosurgery, Children's Hospital of Eastern Ontario, Ottawa, Ont., Canada.
Pediatr Neurosurg. 2009;45(4):247-55. doi: 10.1159/000228982. Epub 2009 Jul 17.
This work evaluated the mortality and functional outcomes of premature infants sustaining intraventricular hemorrhage (IVH). These outcomes were analyzed for their association with IVH severity, development of hydrocephalus and need for ventriculoperitoneal (VP) shunt insertion.
A retrospective review was performed of neonates at the Children's Hospital of Eastern Ontario who sustained IVH (1989-2005). Logistic regression tested demographic predictors of IVH severity, development of hydrocephalus and mortality. Chi(2) analysis differentiated functional outcomes and mortality by IVH grade, development of hydrocephalus and intervention for cerebrospinal fluid diversion. All analyses used the 0.05 significance level.
Data were available for 284 patients with an average follow-up of 5.1 years. These were distributed as grade I (n = 135), grade II (n = 52), grade III (n = 43) and grade IV (n = 54), with lower gestational age and birth weight predicting disease severity. Hydrocephalus developed in 21% of patients, of whom 39% required VP shunt insertion. Overall mortality of 20% depended on IVH grade and was highest for grade IV patients (59%). Functional independence diminished with IVH severity, and patients with hydrocephalus fared worse than those without this sequel. Outcomes of patients developing hydrocephalus were similar whether or not they eventually required VP shunt insertion.
This study describes a large cohort of neonatal IVH, describing how disease severity affects mortality and functional outcome. The overall mortality of nearly 1 in 5 patients is primarily of grade IV patients, with no difference between grade II and grade III. Further, patients surviving their hydrocephalus exhibited no worse functional deterioration if they required surgical intervention.
本研究评估了发生脑室内出血（IVH）的早产儿的死亡率和功能转归。分析了这些转归与IVH严重程度、脑积水的发生以及脑室腹腔（VP）分流术置入需求之间的关联。
对安大略东部儿童医院1989 - 2005年间发生IVH的新生儿进行回顾性研究。逻辑回归分析检验了IVH严重程度、脑积水发生及死亡率的人口统计学预测因素。卡方分析按IVH分级、脑积水发生情况及脑脊液分流干预措施区分功能转归和死亡率。所有分析采用0.05的显著性水平。
284例患者资料齐全，平均随访5.1年。IVH分级为I级（n = 135）、II级（n = 52）、III级（n = 43）和IV级（n = 54），较低的胎龄和出生体重预示疾病严重程度。21%的患者发生脑积水，其中39%需要置入VP分流管。总体死亡率为20%，取决于IVH分级，IV级患者死亡率最高（59%）。功能独立性随IVH严重程度降低，发生脑积水的患者比未发生此并发症的患者预后更差。无论最终是否需要置入VP分流管，发生脑积水患者的转归相似。
本研究描述了一大群新生儿IVH病例，阐述了疾病严重程度如何影响死亡率和功能转归。近五分之一患者的总体死亡率主要见于IV级患者，II级和III级之间无差异。此外，脑积水存活患者若需要手术干预其功能恶化情况并不更严重。
