Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Medicine (Baltimore). 2022 Jul 29;101(30):e29598. doi: 10.1097/MD.0000000000029598.
The increased survival rate among very low birth weight infants has resulted in a higher risk for developing neuro-complications such as intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and adverse neurodevelopmental outcomes.
We examined refractory hypotension experienced within a week of life in association with severe IVH (grades 3-4) among very low birth weight infants (VLBWIs).
Between Jan 2014 and Dec 2017, the clinical data of 191 VLBWIs were retrospectively chart reviewed. Of a total of 191 VLBWIs, 71.2% (136/191) had IVH, and 28.7% (55/191) had severe IVH.
The VLBWI with severe IVH group (grade 3-4) presented with a significantly lower gestational age along with higher use of postnatal hydrocortisone for refractory hypotension within a week of life. Resuscitation at delivery, pulmonary hemorrhage, neonatal seizure, and PVL were significantly more frequent in the severe IVH group (P < .05). Higher mortality occurred in the VLBWI with severe IVH group (P < .001). The multivariable logistic regression analysis consistently showed that refractory hypotension within a week of life and neonatal seizures were significantly associated with severe IVH. Those in the severe IVH and refractory hypotension groups had significantly lower composite cognitive, language, motor scores in Bayley Scales of Infant and Toddler Development III scores at corrected 18-24 months.
Refractory hypotension within a week of life and seizures were consistently associated with severe IVH and developmental delay at corrected 18-24 months. VLBWI who experienced refractory hypotension within a week of life may indicate a more vulnerable clinical setting with a higher risk for developmental delay.
极低出生体重儿（VLBW）的存活率提高导致发生神经并发症的风险增加，例如脑室周围出血（IVH）、脑室周围白质软化（PVL）和不良神经发育结局。
我们研究了 VLBW 儿在生命的第一周内经历难治性低血压与严重 IVH（3-4 级）之间的关联。
2014 年 1 月至 2017 年 12 月，回顾性分析了 191 例 VLBWI 的临床资料。在总共 191 例 VLBWI 中，71.2%（136/191）有 IVH，28.7%（55/191）有严重 IVH。
严重 IVH 组（3-4 级）的 VLBWI 呈现出显著更低的胎龄，以及在生命的第一周内需要更多的氢化可的松来治疗难治性低血压。严重 IVH 组在出生时复苏、肺出血、新生儿癫痫和 PVL 方面更为常见（P<0.05）。严重 IVH 组的死亡率更高（P<0.001）。多变量逻辑回归分析一致表明，生命第一周内难治性低血压和新生儿癫痫与严重 IVH 显著相关。在严重 IVH 和难治性低血压组中，Bayley 婴儿和幼儿发展量表 III 校正后 18-24 个月的综合认知、语言、运动评分显著较低。
生命第一周内难治性低血压和癫痫与严重 IVH 和校正后 18-24 个月的发育迟缓始终相关。在生命的第一周内经历难治性低血压的 VLBWI 可能表明其处于更脆弱的临床环境中，发生发育迟缓的风险更高。
