Departments of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western ReserveUniversity, Cleveland, OH 44106, USA.
JAMA Pediatr. 2013 May;167(5):451-9. doi: 10.1001/jamapediatrics.2013.866.
Low-grade periventricular-intraventricular hemorrhage is a common neurologic morbidity among extremely low-gestational-age neonates, yet the outcomes associated with this morbidity are not fully understood. In a contemporary multicenter cohort, we evaluated the impact of such hemorrhages on early (18-22 month) neurodevelopmental outcomes of extremely premature infants.
To compare neurodevelopmental outcomes at 18 to 22 months' corrected age for extremely low-gestational-age infants with low-grade (grade 1 or 2) periventricular-intraventricular hemorrhage with those of infants with either no hemorrhage or severe (grade 3 or 4) hemorrhage demonstrated on cranial ultrasonography.
Longitudinal observational study.
Sixteen centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.
A total of 1472 infants born at less than 27 weeks' gestational age between January 1, 2006, and December 31, 2008, with ultrasonography results within the first 28 days of life and surviving to 18 to 22 months with complete follow-up assessments were eligible.
Low-grade periventricular-intraventricular hemorrhage.
Outcomes included cerebral palsy; gross motor functional limitation; cognitive and language scores according to the Bayley Scales of Infant Development, 3rd Edition; and composite measures of neurodevelopmental impairment. Regression modeling evaluated the association of hemorrhage severity with adverse outcomes while controlling for potentially confounding variables and center differences.
Low-grade hemorrhage was not associated with significant differences in unadjusted or adjusted risk of any adverse neurodevelopmental outcome compared with infants without hemorrhage. Compared with low-grade hemorrhage, severe hemorrhage was associated with decreased adjusted continuous cognitive (β, -3.91 [95% CI, -6.41 to -1.42]) and language (β, -3.19 [-6.19 to -0.19]) scores as well as increased odds of each adjusted categorical outcome except severe cognitive impairment (odds ratio [OR], 1.46 [0.74 to 2.88]) and mild language impairment (OR, 1.35 [0.88 to 2.06]).
At 18 to 22 months, the neurodevelopmental outcomes of extremely low-gestational-age infants with low-grade periventricular-intraventricular hemorrhage are not significantly different from those without hemorrhage. Additional study at school age and beyond would be informative.
低级别脑室内-脑室内出血是极低出生体重儿常见的神经系统疾病，但与这种疾病相关的结局尚不完全清楚。在一项当代多中心队列研究中，我们评估了极低出生体重儿的这种出血对其早期（18-22 个月龄）神经发育结局的影响。
比较极低出生体重儿脑室内-脑室内出血低级别（1 级或 2 级）与颅超声检查显示无出血或严重（3 级或 4 级）出血的婴儿在 18-22 个月龄校正年龄时的神经发育结局。
纵向观察性研究。
美国国立儿童健康与人类发育 Eunice Kennedy Shriver 研究所新生儿研究网络的 16 个中心。
2006 年 1 月 1 日至 2008 年 12 月 31 日出生胎龄小于 27 周，出生后 28 天内进行超声检查，且生存至 18-22 个月龄并完成了完整随访评估的 1472 名婴儿符合入选标准。
低级别脑室内-脑室内出血。
结局包括脑瘫；粗大运动功能受限；根据贝利婴幼儿发展量表第三版评估的认知和语言评分；以及神经发育障碍的综合指标。回归模型评估了出血严重程度与不良结局的关联，同时控制了潜在的混杂变量和中心差异。
与无脑内出血的婴儿相比，低级别出血在未经调整或调整后的任何不良神经发育结局风险方面均无显著差异。与低级别出血相比，严重出血与调整后的连续认知（β，-3.91[95%CI，-6.41 至-1.42]）和语言（β，-3.19[-6.19 至-0.19]）评分降低以及除严重认知障碍（比值比[OR]，1.46[0.74 至 2.88]）和轻度语言障碍（OR，1.35[0.88 至 2.06]）以外的每个调整后的分类结局的可能性增加相关。
极低出生体重儿低级别脑室内-脑室内出血在 18-22 个月龄时的神经发育结局与无脑内出血的婴儿无显著差异。在校龄及以后进行进一步研究将提供更多信息。
