极低胎龄儿出血后脑室扩张的结局。
Outcomes Following Post-Hemorrhagic Ventricular Dilatation among Infants of Extremely Low Gestational Age.
机构信息
Department of Pediatrics, Wayne State University, Detroit, MI.
Department of Pediatrics, Wayne State University, Detroit, MI.
出版信息
J Pediatr. 2020 Nov;226:36-44.e3. doi: 10.1016/j.jpeds.2020.07.080. Epub 2020 Jul 30.
OBJECTIVE
To assess outcomes following post-hemorrhagic ventricular dilatation (PHVD) among infants born at ≤26 weeks of gestation.
STUDY DESIGN
Observational study of infants born April 1, 2011, to December 31, 2015, in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and categorized into 3 groups: PHVD, intracranial hemorrhage without ventricular dilatation, or normal head ultrasound. PHVD was treated per center practice. Neurodevelopmental impairment at 18-26 months was defined by cerebral palsy, Bayley Scales of Infant and Toddler Development, 3rd edition, cognitive or motor score <70, blindness, or deafness. Multivariable logistic regression examined the association of death or impairment, adjusting for neonatal course, center, maternal education, and parenchymal hemorrhage.
RESULTS
Of 4216 infants, 815 had PHVD, 769 had hemorrhage without ventricular dilatation, and 2632 had normal head ultrasounds. Progressive dilatation occurred among 119 of 815 infants; the initial intervention in 66 infants was reservoir placement and 53 had ventriculoperitoneal shunt placement. Death or impairment occurred among 68%, 39%, and 28% of infants with PHVD, hemorrhage without dilatation, and normal head ultrasound, respectively; aOR (95% CI) were 4.6 (3.8-5.7) PHVD vs normal head ultrasound scan and 2.98 (2.3-3.8) for PHVD vs hemorrhage without dilatation. Death or impairment was more frequent with intervention for progressive dilatation vs no intervention (80% vs 65%; aOR 2.2 [1.38-3.8]). Death or impairment increased with parenchymal hemorrhage, intervention for PHVD, male sex, and surgery for retinopathy; odds decreased with each additional gestational week.
CONCLUSIONS
PHVD was associated with high rates of death or impairment among infants with gestational ages ≤26 weeks; risk was further increased among those with progressive ventricular dilation requiring intervention.
目的
评估胎龄≤26 周早产儿发生脑室内出血后扩张（PHVD）的结局。
研究设计
这是一项观察性研究，纳入 2011 年 4 月 1 日至 2015 年 12 月 31 日在 Eunice Kennedy Shriver 国家儿童健康与人类发育研究所新生儿研究网络中出生的婴儿，并分为 3 组：PHVD 组、颅内出血无脑室扩张组或正常头颅超声组。PHVD 按照中心实践进行治疗。18-26 个月时的神经发育障碍定义为脑瘫、贝利婴幼儿发育量表第三版认知或运动评分<70、失明或耳聋。多变量逻辑回归检查了死亡或损害的相关性，调整了新生儿病程、中心、母亲教育和实质内出血。
结果
在 4216 名婴儿中，815 名患有 PHVD，769 名患有无脑室扩张的出血，2632 名婴儿头颅超声正常。815 名婴儿中有 119 名出现进行性扩张；66 名婴儿的初始干预措施是放置储液池，53 名婴儿行脑室-腹腔分流术。PHVD、无脑室扩张出血和正常头颅超声组的婴儿死亡率或致残率分别为 68%、39%和 28%；PHVD 与正常头颅超声扫描相比，aOR（95%CI）为 4.6（3.8-5.7），PHVD 与无脑室扩张出血相比为 2.98（2.3-3.8）。与无干预相比，进行性扩张的干预治疗（80% vs 65%；aOR 2.2 [1.38-3.8]）后死亡率或致残率更高。死亡或残疾的风险随着实质内出血、PHVD 的干预、男性和视网膜病变手术的增加而增加；随着每个额外的妊娠周数的增加，几率降低。
结论
胎龄≤26 周的婴儿 PHVD 与高死亡率或残疾率相关；进行性脑室扩张需要干预的婴儿风险进一步增加。
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