Department of Pediatrics, Wayne State University, Detroit, Michigan.
Emory University School of Medicine, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia.
JAMA Pediatr. 2018 Jan 1;172(1):32-42. doi: 10.1001/jamapediatrics.2017.3545.
Studies of cranial ultrasonography and early childhood outcomes among cohorts of extremely preterm neonates have linked periventricular-intraventricular hemorrhage and cystic periventricular leukomalacia with adverse neurodevelopmental outcomes. However, the association between nonhemorrhagic ventriculomegaly and neurodevelopmental and behavioral outcomes is not fully understood.
To characterize the outcomes of extremely preterm neonates younger than 27 weeks' gestational age who experienced nonhemorrhagic ventriculomegaly that was detected prior to 36 weeks' postmenstrual age.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal observational study was conducted at 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants born prior to 27 weeks' gestational age in any network facility between July 1, 2006, and June 30, 2011, were included if they had a cranial ultrasonogram performed prior to 36 weeks' postmenstrual age. Comparisons were made between those with ventriculomegaly and those with normal cranial sonograms. Data analysis was completed from August 2013 to August 2017.
The main outcome was neurodevelopmental impairment, defined as a Bayley Scales of Infant and Toddler Development III cognitive score less than 70, moderate/severe cerebral palsy, a Gross Motor Function Classification System score of level 2 or more, vision impairment, or hearing impairment. Secondary outcomes included Bayley Scales of Infant and Toddler Development III subscores, components of neurodevelopmental impairment, behavioral outcomes, and death/neurodevelopmental impairment. Logistic regression was used to evaluate the association of ventriculomegaly with adverse outcomes while controlling for potentially confounding variables and center differences as a random effect. Linear regression was used similarly for continuous outcomes.
Of 4193 neonates with ultrasonography data, 300 had nonhemorrhagic ventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomes were available for 3008 of 3345 neonates with ventriculomegaly or normal scans (90%). Compared with normal cranial ultrasonograms, ventriculomegaly was associated with lower gestational age, male sex, and bronchopulmonary dysplasia, late-onset sepsis, meningitis, necrotizing enterocolitis, and stage 3 retinopathy of prematurity. After adjustment, neonates with ventriculomegaly had higher odds of neurodevelopmental impairment (odds ratio [OR], 3.07; 95% CI, 2.13-4.43), cognitive impairment (OR, 3.23; 95% CI, 2.09-4.99), moderate/severe cerebral palsy (OR, 3.68; 95% CI, 2.08-6.51), death/neurodevelopmental impairment (OR, 2.17; 95% CI, 1.62-2.91), but not death alone (OR, 1.09; 95% CI, 0.76-1.57). Behavioral outcomes did not differ.
Nonhemorrhagic ventriculomegaly is associated with increased odds of neurodevelopmental impairment among extremely preterm neonates.
对极早产儿队列的颅超声检查和幼儿期结局的研究表明，脑室周围-脑室内出血和囊性脑室周围白质软化与不良神经发育结局有关。然而，非出血性脑室扩大与神经发育和行为结果之间的关联尚未完全清楚。
描述在 36 周龄前检测到非出血性脑室扩大的极早产儿（胎龄<27 周）的结局。
设计、地点和参与者：这是一项纵向观察性研究，在 Eunice Kennedy Shriver 国立儿童健康与人类发展研究所新生儿研究网络的 16 个中心进行。2006 年 7 月 1 日至 2011 年 6 月 30 日期间，任何网络机构中胎龄<27 周的新生儿均被纳入研究，如果他们在 36 周龄前进行了头颅超声检查。将脑室扩大的患儿与正常头颅超声的患儿进行比较。数据分析于 2013 年 8 月至 2017 年 8 月进行。
主要结局是神经发育障碍，定义为贝利婴幼儿发育量表 III 认知评分<70、中重度脑瘫、粗大运动功能分类系统评分≥2 级、视力障碍或听力障碍。次要结局包括贝利婴幼儿发育量表 III 子评分、神经发育障碍的组成部分、行为结果和死亡/神经发育障碍。采用 logistic 回归评估脑室扩大与不良结局的相关性，同时控制潜在混杂变量和中心差异作为随机效应。类似地，采用线性回归评估连续结局。
在 4193 名有超声数据的新生儿中，300 名新生儿有非出血性脑室扩大（7%）；3045 名新生儿有正常的头颅超声（73%），775 名新生儿有脑室周围-脑室内出血（18.5%），73 名新生儿有囊性脑室周围白质软化（1.7%）。3008 名脑室扩大或正常扫描的新生儿中有 3008 名（90%）的结局可用。与正常头颅超声相比，脑室扩大与较低的胎龄、男性和支气管肺发育不良、晚发性败血症、脑膜炎、坏死性小肠结肠炎和 3 期早产儿视网膜病变有关。调整后，脑室扩大的新生儿神经发育障碍的可能性更高（比值比[OR]，3.07；95%CI，2.13-4.43）、认知障碍（OR，3.23；95%CI，2.09-4.99）、中重度脑瘫（OR，3.68；95%CI，2.08-6.51）、死亡/神经发育障碍（OR，2.17；95%CI，1.62-2.91），但不是死亡（OR，1.09；95%CI，0.76-1.57）。行为结果无差异。
极早产儿的非出血性脑室扩大与神经发育障碍的几率增加有关。
