Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Pediatr Res. 2022 Apr;91(5):1238-1247. doi: 10.1038/s41390-021-01631-2. Epub 2021 Jul 2.
Greater ventriculomegaly in preterm infants with intraventricular hemorrhage (IVH) has been associated with worse neurodevelopmental outcomes in infancy. We aim to explore the relationship between ventriculomegaly and school-age functional outcome.
Retrospective review of preterm infants with Grade III/IV IVH from 2006 to 2020. Frontal-occipital horn ratio (FOHR) was measured on imaging throughout hospitalization and last available follow-up scan. Pediatric Cerebral Performance Category (PCPC) scale was used to assess functional outcome at ≥4 years. Ordinal logistic regression was used to determine the relationship between functional outcome and FOHR at the time of Neurosurgery consult, neurosurgical intervention, and last follow-up scan while adjusting for confounders.
One hundred and thirty-four infants had Grade III/IV IVH. FOHR at consult was 0.62 ± 0.12 and 0.75 ± 0.13 at first intervention (p < 0.001). On univariable analysis, maximum FOHR, FOHR at the last follow-up scan, and at Neurosurgery consult predicted worse functional outcome (p < 0.01). PVL, longer hospital admission, and gastrotomy/tracheostomy tube also predicted worse outcome (p < 0.05). PVL, maximum FOHR, and FOHR at consult remained significant on multivariable analysis (p < 0.05). Maximum FOHR of 0.61 is a fair predictor for moderate-severe impairment (AUC 75%, 95% CI: 62-87%).
Greater ventricular dilatation and PVL were independently associated with worse functional outcome in Grade III/IV IVH regardless of neurosurgical intervention.
Ventriculomegaly measured by frontal-occipital horn ratio (FOHR) and periventricular leukomalacia are independent correlates of school-age functional outcomes in preterm infants with intraventricular hemorrhage regardless of need for neurosurgical intervention. These findings extend the known association between ventriculomegaly and neurodevelopmental outcomes in infancy to functional outcomes at school age. FOHR is a fair predictor of school-age functional outcome, but there are likely other factors that influence functional status, which highlights the need for prospective studies to incorporate other clinical and demographic variables in predictive models.
患有脑室内出血（IVH）的早产儿脑室扩大程度越大，其在婴儿期的神经发育结局越差。我们旨在探讨脑室扩大与学龄期功能结局的关系。
回顾性分析 2006 年至 2020 年间患有 III/IV 级 IVH 的早产儿。在住院期间和最后一次可获得的随访扫描中测量额枕角比率（FOHR）。儿科脑功能表现分类（PCPC）量表用于评估≥4 岁时的功能结局。采用有序逻辑回归来确定在神经外科会诊、神经外科干预以及最后一次随访扫描时的功能结局与 FOHR 之间的关系，同时调整混杂因素。
共有 134 名婴儿患有 III/IV 级 IVH。在会诊时的 FOHR 为 0.62±0.12，第一次干预时为 0.75±0.13（p<0.001）。在单变量分析中，最大 FOHR、最后一次随访扫描时的 FOHR 和神经外科会诊时的 FOHR 预测功能结局较差（p<0.01）。PVL、较长的住院时间以及胃造口/气管造口管也预测结局较差（p<0.05）。PVL、最大 FOHR 和会诊时的 FOHR 在多变量分析中仍然具有统计学意义（p<0.05）。最大 FOHR 为 0.61 是中度至重度损伤的良好预测指标（AUC 为 75%，95%CI：62-87%）。
脑室扩大和 PVL 与 III/IV 级 IVH 患者的功能结局较差独立相关，无论是否需要神经外科干预。
通过额枕角比率（FOHR）和脑室周围白质软化测量的脑室扩大与 IVH 早产儿的学龄期功能结局相关，无论是否需要神经外科干预。这些发现将脑室扩大与婴儿期神经发育结局的已知关联扩展到学龄期的功能结局。FOHR 是学龄期功能结局的良好预测指标，但可能还有其他影响功能状态的因素，这突出表明需要前瞻性研究将其他临床和人口统计学变量纳入预测模型。
