Maitre Nathalie L, Marshall Diane D, Price Wayne A, Slaughter James C, O'Shea Thomas M, Maxfield Charles, Goldstein Ricki F
Department of Pediatrics, Monroe Carell Children's Hospital at Vanderbilt, Nashville, Tennessee 37232-9544, USA.
Pediatrics. 2009 Dec;124(6):e1153-60. doi: 10.1542/peds.2009-0953.
Periventricular hemorrhagic infarction (PVHI) is a major contributing factor to poor neurodevelopmental outcomes in preterm infants. We hypothesized that surviving infants with unilateral PVHI would have more favorable outcomes than those with bilateral PVHI.
This was a multicenter, retrospective study of infants who were admitted to 3 NICUs in North Carolina from 1998 to 2004. The clinical course and late neuroimaging studies and neurodevelopmental outcomes of 69 infants who weighed <1500 g and had confirmed PVHI on early cranial ultrasonography were reviewed. A predictive model for Bayley Scales of Infant Development, Second Edition, Mental Developmental Index (MDI) <70 was constructed by using radiologic and clinical variables.
Infants with unilateral PVHI had higher median MDI (82 vs 49) and Psychomotor Developmental Index (53 vs 49) than infants with bilateral PVHI. Infants with unilateral PVHI were less likely to have severe cerebral palsy (adjusted odds ratio: 0.15 [95% confidence interval (CI): 0.05-0.45]) than infants with bilateral PVHI. Infants who had unilateral PVHI and developed periventricular leukomalacia and retinopathy of prematurity that required surgery had an increased probability of having MDI <70 compared with those without these complications (probability of MDI <70: 89% [95% CI: 0.64-1.00] vs 11% [95% CI: 0.01-0.28]).
Infants with unilateral PVHI had better motor and cognitive outcomes than infants with bilateral PVHI. By combining laterality of PVHI, periventricular leukomalacia, and retinopathy of prematurity it is possible to estimate the probability of having an MDI <70, which will assist clinicians when counseling families.
脑室周围出血性梗死（PVHI）是导致早产儿神经发育不良结局的主要因素。我们假设，存活的单侧PVHI婴儿比双侧PVHI婴儿的预后更良好。
这是一项对1998年至2004年入住北卡罗来纳州3家新生儿重症监护病房的婴儿进行的多中心回顾性研究。回顾了69例体重<1500 g且早期头颅超声检查确诊为PVHI的婴儿的临床病程、晚期神经影像学检查及神经发育结局。利用放射学和临床变量构建了贝利婴儿发育量表第二版心理发育指数（MDI）<70的预测模型。
单侧PVHI婴儿的MDI中位数（82对49）和精神运动发育指数（53对49）高于双侧PVHI婴儿。与双侧PVHI婴儿相比，单侧PVHI婴儿患重度脑瘫的可能性较小（调整比值比：0.15 [95%置信区间（CI）：0.05 - 0.45]）。与无这些并发症的婴儿相比，患有单侧PVHI且发生脑室周围白质软化和需要手术治疗的早产儿视网膜病变的婴儿MDI<70的概率增加（MDI<70的概率：89% [95% CI：0.64 - 1.00]对11% [95% CI：0.01 - 0.28]）。
单侧PVHI婴儿的运动和认知结局优于双侧PVHI婴儿。通过结合PVHI的侧别、脑室周围白质软化和早产儿视网膜病变，可以估计MDI<70的概率，这将有助于临床医生为家庭提供咨询。
