Department of Pediatrics, All India Institute of Medical Sciences, New Delhi.
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi. Correspondence to: Dr Ashok K Deorari, Professor and Head, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110 029.
Indian Pediatr. 2021 Oct 15;58(10):922-927. Epub 2021 Jul 23.
To determine the incidence and risk factors of preterm white matter injury [WMI; periventricular-intraventricular hemorrhage (PIVH) and/or periventricular leukomalacia (PVL)].
Prospective cohort study.
Level-3 neonatal intensive care unit.
Inborn preterm neonates (n=140) delivered at <32 weeks gestation or birthweight <1500 g.
Serial cranial ultrasounds were performed at postnatal ages of 3 days (±12 hour), 7 (±1) days, 21 (±3) days and 40 (±1) weeks postmenstrual age (PMA). PIVH and PVL were graded as per Volpe and De-Vries criteria, respectively. Univariate followed by multivariate analysis was done to evaluate risk factors for PIVH and PVL.
The primary outcome was the incidence of preterm WMI. The secondary outcomes were evaluation of risk factors and natural course of WMI.
The mean (range) gestation and birth weight of enrolled neonates were 29.7 (24-36) weeks and 1143 (440-1887) g, respectively. PIVH occurred in 25 (17.8%) neonates. PVL occurred in 34 (24.3%) neonates. None of them were grade III or IV PVL. Preterm WMI (any grade PIVH and/or PVL) occurred in 52 (37.1%) neonates. Severe PIVH (grade III) and cystic PVL occurred in 7 (5%) and 5 (3.6%) neonates, respectively. On multivariate analysis, none of the presumed risk factors were associated with PIVH. However, hemodynamically significant patent ductus arteriosus, and apnea of prematurity were significantly associated with increased risk of PVL.
Significant WMI occurred only in one-third of the cohort, which is comparable to that described in literature from the developed countries.
确定早产儿脑白质损伤（WMI；脑室周围-脑室内出血（PIVH）和/或脑室周围白质软化（PVL））的发生率和危险因素。
前瞻性队列研究。
三级新生儿重症监护病房。
胎龄<32 周或出生体重<1500 克的早产儿（n=140）。
对出生后 3 天（±12 小时）、7（±1）天、21（±3）天和 40（±1）周校正胎龄（PMA）进行连续头颅超声检查。根据 Volpe 和 De-Vries 标准对 PIVH 和 PVL 进行分级。采用单因素和多因素分析评估 PIVH 和 PVL 的危险因素。
主要结局为早产儿 WMI 的发生率。次要结局为评估危险因素和 WMI 的自然病程。
纳入新生儿的平均（范围）胎龄和出生体重分别为 29.7（24-36）周和 1143（440-1887）g。25 例（17.8%）新生儿发生 PIVH，34 例（24.3%）新生儿发生 PVL。无 III 或 IV 级 PVL。52 例（37.1%）新生儿出现早产儿 WMI（任何等级的 PIVH 和/或 PVL）。7 例（5%）和 5 例（3.6%）新生儿分别发生严重 PIVH（III 级）和囊性 PVL。多因素分析显示，无任何假定的危险因素与 PIVH 相关。然而，有临床意义的动脉导管未闭和早产儿呼吸暂停与 PVL 风险增加显著相关。
只有三分之一的队列发生了显著的 WMI，这与发达国家文献描述的情况相当。
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