Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
J Pediatr. 2019 May;208:191-197.e2. doi: 10.1016/j.jpeds.2018.12.062. Epub 2019 Mar 14.
To compare the effect of early and late intervention for posthemorrhagic ventricular dilatation on additional brain injury and ventricular volume using term-equivalent age-MRI.
In the Early vs Late Ventricular Intervention Study (ELVIS) trial, 126 preterm infants ≤34 weeks of gestation with posthemorrhagic ventricular dilatation were randomized to low-threshold (ventricular index >p97 and anterior horn width >6 mm) or high-threshold (ventricular index >p97 + 4 mm and anterior horn width >10 mm) groups. In 88 of those (80%) with a term-equivalent age-MRI, the Kidokoro Global Brain Abnormality Score and the frontal and occipital horn ratio were measured. Automatic segmentation was used for volumetric analysis.
The total Kidokoro score of the infants in the low-threshold group (n = 44) was lower than in the high-threshold group (n = 44; median, 8 [IQR, 5-12] vs median 12 [IQR, 9-17], respectively; P < .001). More infants in the low-threshold group had a normal or mildly increased score vs more infants in the high-threshold group with a moderately or severely increased score (46% vs 11% and 89% vs 54%, respectively; P = .002). The frontal and occipital horn ratio was lower in the low-threshold group (median, 0.42 [IQR, 0.34-0.63]) than the high-threshold group (median 0.48 [IQR, 0.37-0.68], respectively; P = .001). Ventricular cerebrospinal fluid volumes could be calculated in 47 infants and were smaller in the low-threshold group (P = .03).
More brain injury and larger ventricular volumes were demonstrated in the high vs the low-threshold group. These results support the positive effects of early intervention for posthemorrhagic ventricular dilatation.
ISRCTN43171322.
使用足月龄等时磁共振成像（MRI）比较早、晚期干预对晚发性脑室内出血（posthemorrhagic ventricular dilatation，PHVD）患儿继发脑损伤和脑室容积的影响。
在早、晚期脑室内干预研究（Early vs Late Ventricular Intervention Study，ELVIS）中，126 例胎龄≤34 周伴 PHVD 的早产儿随机分为低阈值（脑室指数＞第 97 百分位数且前角宽度＞6mm）或高阈值（脑室指数＞第 97 百分位数+4mm 且前角宽度＞10mm）组。88 例（80%）具有足月龄等时 MRI 的患儿测量了 Kidokoro 整体脑异常评分和额角与枕角比值，并采用自动分割进行容积分析。
低阈值组（n=44）患儿的总 Kidokoro 评分低于高阈值组（n=44；中位数 8[四分位数间距（IQR）5-12]比中位数 12[IQR 9-17]；P＜0.001）。低阈值组中评分正常或轻度升高的患儿比例高于高阈值组（分别为 46%比 11%和 89%比 54%；P=0.002）。低阈值组的额角与枕角比值更低（中位数 0.42[IQR 0.34-0.63]），而高阈值组的比值更高（中位数 0.48[IQR 0.37-0.68]；P=0.001）。47 例患儿的脑室脑脊液容积可计算，低阈值组的容积更小（P=0.03）。
高阈值组的脑损伤和脑室容积大于低阈值组。这些结果支持早期干预对 PHVD 的积极作用。
ISRCTN43171322。
