Catto-Smith A G, Yu V Y, Bajuk B, Orgill A A, Astbury J
Arch Dis Child. 1985 Jan;60(1):8-11. doi: 10.1136/adc.60.1.8.
All 56 infants born between 23 and 28 weeks' gestation admitted to this hospital in 1981 were examined for periventricular haemorrhage with cerebral ultrasonography. Haemorrhage was diagnosed in 34 (61%)-12 (22%) had germinal layer haemorrhage, 18 (32%) had intraventricular haemorrhage, and four (7%) had intracerebral haemorrhage. The two year outcome of survivors with and without periventricular haemorrhage was compared to determine the effect on neurodevelopment. Only three (16%) of 19 infants with normal scans or germinal layer haemorrhages had evidence of major disability but nine (75%) of 12 infants with intraventricular or intracerebral haemorrhage had major disability. The mental and psychomotor performance on the Bayley scales of infant development was also significantly worse in the latter group. All three survivors with intracerebral haemorrhage had major disability. The continuation of life support treatment for extremely preterm infants who are at very high risk of severe handicap is a matter of increasing concern in neonatal intensive care. Our results show that if extensive periventricular haemorrhage, in particular intracerebral haemorrhage, occurs in this gestational group, extreme pessimism is warranted.
1981年入住本院的56例孕23至28周出生的婴儿均接受了脑超声检查以诊断脑室周围出血。34例（61%）诊断为出血，其中12例（22%）为生发层出血，18例（32%）为脑室内出血，4例（7%）为脑实质内出血。比较了有和没有脑室周围出血的存活者的两年预后，以确定其对神经发育的影响。19例扫描正常或有生发层出血的婴儿中只有3例（16%）有严重残疾的证据，但12例脑室内或脑实质内出血的婴儿中有9例（75%）有严重残疾。后一组婴儿在贝利婴儿发育量表上的智力和心理运动表现也明显更差。所有3例脑实质内出血的存活者均有严重残疾。对于极有可能出现严重残疾的极早产儿，继续进行生命支持治疗在新生儿重症监护中越来越受到关注。我们的结果表明，如果在这个孕周组发生广泛的脑室周围出血，尤其是脑实质内出血，那么极度悲观是有道理的。
