Amaral Joana, Peixoto Sara, Faria Dolores, Resende Cristina, Taborda Adelaide
Unidade de Cuidados Intensivos Neonatais. Serviço de Neonatologia B. Maternidade Bissaya Barreto. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.
Acta Med Port. 2022 Jan 3;35(1):42-50. doi: 10.20344/amp.12295. Epub 2020 Oct 30.
Severe peri-intraventricular haemorrhage has been associated with higher mortality and neurodevelopmental impairment. The impact of peri-intraventricular haemorrhage alone (without white matter injury) remains controversial. The aim of this study was to evaluate the influence of severe peri-intraventricular haemorrhage, associated or not with cystic peri-ventricular leukomalacia, on mortality and neurodevelopment at 24 months.
Retrospective cohort study, that included newborns with severe peri-intraventricular haemorrhage admitted to a maternity hospital with differentiated perinatal support between 2006 and 2015, and two controls with the same gestational age, without peri-intraventricular haemorrhage, who were admitted immediately after the case. Neurodevelopmental assessment, at 24 months, was performed in 99 children, using the Schedule of Growing Skills II scale in 52 and the Ruth Griffiths mental development scale in 47 children. Severe neurodevelopmental deficit was diagnosed in the following conditions: cerebral palsy, delayed psychomotor development, deafness requiring hearing aids and blindness.
The study included 41 cases and 82 controls. Out of these, 23 died, 16 (39.0%) in the group of severe peri-intraventricular haemorrhage and seven (8.5%) in the control group (OR 7.6, 95% CI 2.6 - 20.4, p < 0.001). Severe neurodevelopmental deficit was diagnosed in seven (30.4%) in the severe peri-intraventricular haemorrhage group and one (1.3%) in the control group (OR 32; 95% CI 3.7 - 281, p < 0.001). Individualized analysis showed that mortality was higher in peri-intraventricular haemorrhage grade III with associated cystic peri-ventricular leukomalacia (OR 4.4 95% CI 1.3 - 14.2, p = 0.015) and in peri-intraventricular haemorrhage IV (OR 12; 95% CI 3.5 - 41.2, p < 0.001), when compared to controls. Differences were also noticed regarding severe neurodevelopmental deficit when compared with controls (1.3%) in grade III peri-intraventricular haemorrhage with associated cystic peri-ventricular leukomalacia, (75.0%, p < 0.001) and grade IV peri-intraventricular haemorrhage (50.0%, p < 0.001 ).
This work showed a higher mortality rate and neurodevelopment impairment in preterm newborns with severe peri-ventricular haemorrhage. Analysis by groups stratified according to gestational age and different grades of peri-ventricular haemorrhage displayed the complications associated with peri-ventricular haemorrhage grade IV or grade III, with or without cystic peri-ventricular leukomalacia.
Preterm newborns with peri-intraventricular haemorrhage grade IV or grade III with cystic peri-ventricular leukomalacia, had a higher risk of mortality and severe neurodevelopmental impairment.
重度脑室内周围出血与较高的死亡率和神经发育障碍相关。单纯脑室内周围出血（无白质损伤）的影响仍存在争议。本研究的目的是评估重度脑室内周围出血（伴或不伴有囊性脑室周围白质软化）对24个月时死亡率和神经发育的影响。
回顾性队列研究，纳入2006年至2015年期间在一家提供差异化围产期支持的妇产医院收治的重度脑室内周围出血新生儿，以及两名与病例同胎龄、无脑室内周围出血且在病例之后立即入院的对照。对99名儿童在24个月时进行神经发育评估，52名儿童使用《成长技能II量表》，47名儿童使用《露丝·格里菲斯心理发展量表》。在以下情况下诊断为严重神经发育缺陷：脑瘫、精神运动发育迟缓、需要助听器的耳聋和失明。
该研究纳入41例病例和82名对照。其中，23例死亡，重度脑室内周围出血组16例（39.0%），对照组7例（8.5%）（比值比7.6，95%置信区间2.6 - 20.4；p < 0.001）。重度脑室内周围出血组7例（30.4%）诊断为严重神经发育缺陷，对照组1例（1.3%）（比值比32；95%置信区间3.7 - 281；p < 0.001）。个体分析显示，伴有囊性脑室周围白质软化的III级脑室内周围出血（比值比4.4，95%置信区间1.3 - 14.2；p = 0.015）和IV级脑室内周围出血（比值比12；95%置信区间3.5 - 41.2；p < 0.001）的死亡率高于对照组。与对照组（1.3%）相比，伴有囊性脑室周围白质软化的III级脑室内周围出血（75.0%，p < 0.001）和IV级脑室内周围出血（50.0%，p < 0.001）在严重神经发育缺陷方面也存在差异。
这项研究表明，重度脑室周围出血的早产儿死亡率和神经发育受损率更高。根据胎龄和不同等级的脑室周围出血进行分层分组分析显示，IV级或III级脑室周围出血（伴或不伴有囊性脑室周围白质软化）存在相关并发症。
患有IV级或III级脑室内周围出血且伴有囊性脑室周围白质软化的早产儿，死亡风险和严重神经发育障碍风险更高。
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