Coskun Yesim, Isik Semra, Bayram Tevfik, Urgun Kamran, Sakarya Sibel, Akman Ipek
Department of Pediatrics, Goztepe Medical Park Hospital, Bahcesehir University School of Medicine, E5 Uzeri 23 Nisan Sokak No:17 34732 Merdivenkoy/Goztepe, Istanbul, Turkey.
Department of Neurosurgery, Goztepe Medical Park Hospital, Bahcesehir University School of Medicine, Istanbul, Turkey.
Childs Nerv Syst. 2018 Jan;34(1):129-136. doi: 10.1007/s00381-017-3610-z. Epub 2017 Oct 12.
OBJECTıVE: The aim of this study is to develop a scoring system for the prediction of intraventricular hemorrhage (IVH) in preterm infants in the first 7 days of life.
A prospective, clinical study was conducted in Bahcesehir University, Medical Park Goztepe Hospital Neonatal Intensive Care Unit, with the enrollment of 144 preterm infants with gestational age between 24 and 34 weeks. All preterms were followed up for IVH after birth until the 4th week of life. The demographic characteristics and clinical risk factors were noted. Risk factors were analyzed. The score was established after logistic regression analysis, considering the impact of each variable on the occurrence of IVH within the first 7 days of life. The IVH scores were further applied prospectively to 89 preterm infants as validation cohort.
Low gestational age (GA), low Apgar score, and having bleeding diathesis were the most important risk factors for IVH. According to these risk factors, a scoring system was developed for IVH ranged from 0 to 5. According to the risk ratios (RR) obtained from the logistic regression model, low GA (≤ 28 gestational week), presence of bleeding diathesis within 7 days, and low Apgar score increased the risk of IVH (RR = 3.32 for GA ≤ 28 gestational week, RR = 6.7 for presence of bleeding diathesis in 7th day, RR = 3 for having low Apgar score). The score was validated successfully in 89 infants. The area under ROC curve was 0.85 for derivation cohort and 0.807 for validation cohort. The predictive ability of the IVH score for derivation and validation cohort was calculated. The negative predictive values of a score less than 4 were 96.4 and 59.1%. CONCLUSıON: Concerning IVH-related sequelae which continue to be a major public health problem, we have developed a feasible predictive model for evaluating the risk for developing IVH for preterm infants in the first 7 days of life.
目的：本研究旨在开发一种评分系统，用于预测早产儿出生后7天内发生脑室内出血（IVH）的风险。
在巴赫切希尔大学医学公园戈兹特佩医院新生儿重症监护病房进行了一项前瞻性临床研究，纳入了144例孕周在24至34周之间的早产儿。所有早产儿出生后直至生后第4周均接受IVH随访。记录人口统计学特征和临床危险因素。对危险因素进行分析。在逻辑回归分析后建立评分系统，考虑每个变量对出生后7天内IVH发生的影响。IVH评分进一步前瞻性应用于89例早产儿作为验证队列。
低孕周（GA）、低Apgar评分和有出血倾向是IVH最重要的危险因素。根据这些危险因素，开发了一个IVH评分系统，范围为0至5分。根据逻辑回归模型获得的风险比（RR），低GA（≤28孕周）、7天内有出血倾向和低Apgar评分增加了IVH的风险（GA≤28孕周时RR = 3.32，第7天有出血倾向时RR = 6.7，低Apgar评分时RR = 3）。该评分在89例婴儿中成功验证。推导队列的ROC曲线下面积为(0.85)，验证队列的为(0.807)。计算了IVH评分对推导队列和验证队列的预测能力。评分小于4分时的阴性预测值分别为(96.4%)和(59.1%)。结论：鉴于IVH相关后遗症仍是一个主要的公共卫生问题，我们开发了一种可行的预测模型，用于评估早产儿出生后7天内发生IVH的风险。
