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早产儿出血后脑室扩大的流行病学。

Epidemiology of post-hemorrhagic ventricular dilatation in very preterm infants.

机构信息

Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NS, Canada.

Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, ON, Canada.

出版信息

J Perinatol. 2022 Oct;42(10):1392-1399. doi: 10.1038/s41372-022-01483-6. Epub 2022 Aug 9.

DOI:10.1038/s41372-022-01483-6
PMID:35945347
Abstract

OBJECTIVE

To describe the incidence, trends, management's variability and short-term outcomes of preterm infants with severe post-hemorrhagic ventricular dilatation (sPHVD).

METHODS

We reviewed infants <33 weeks' gestation who had PHVD and were admitted to the Canadian Neonatal Network between 2010 and 2018. We compared perinatal characteristics and short-term outcomes between those with sPHVD and those with mild/moderate PHVD and those with and without ventriculo-peritoneal (VP) shunt.

RESULTS

Of 29,417 infants, 2439 (8%) had PHVD; rate increased from 7.3% in 2010 to 9.6% in 2018 (P = 0.005). Among infants with PHVD, sPHVD (19%) and VP shunt (29%) rates varied significantly across Canadian centers and between geographic regions (P < 0.01 and P = 0.0002). On multivariable analysis, sPHVD was associated with greater mortality, seizures and meningitis compared to mild/moderate PHVD.

CONCLUSIONS

Significant variability in sPHVD and VP shunt rates exists between centers and regions in Canada. sPHVD was associated with increased mortality and morbidities.

摘要

目的

描述严重出血后脑室扩张(sPHVD)早产儿的发病率、趋势、管理变异性和短期结局。

方法

我们回顾了 2010 年至 2018 年间在加拿大新生儿网络中患有 PHVD 且胎龄<33 周的婴儿。我们比较了 sPHVD 与轻度/中度 PHVD 以及有和无脑室-腹膜(VP)分流的围产期特征和短期结局。

结果

在 29417 名婴儿中,有 2439 名(8%)患有 PHVD;发病率从 2010 年的 7.3%增加到 2018 年的 9.6%(P=0.005)。在患有 PHVD 的婴儿中,sPHVD(19%)和 VP 分流(29%)的比率在加拿大各中心和地理区域之间存在显著差异(P < 0.01 和 P = 0.0002)。多变量分析显示,与轻度/中度 PHVD 相比,sPHVD 与更高的死亡率、癫痫发作和脑膜炎相关。

结论

加拿大各中心和地区之间在 sPHVD 和 VP 分流率方面存在显著差异。sPHVD 与死亡率和发病率增加有关。

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本文引用的文献

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Timing of Intervention for Posthemorrhagic Ventricular Dilatation: An Ongoing Debate.出血后脑室扩张的干预时机:一场仍在进行的辩论。
J Pediatr. 2021 Jul;234:14-16. doi: 10.1016/j.jpeds.2021.02.022. Epub 2021 Feb 13.
2
Timing of Temporizing Neurosurgical Treatment in Relation to Shunting and Neurodevelopmental Outcomes in Posthemorrhagic Ventricular Dilatation of Prematurity: A Meta-analysis.早产儿出血后脑积水分流与神经发育结局相关的暂时机能性神经外科治疗时机:一项荟萃分析。
J Pediatr. 2021 Jul;234:54-64.e20. doi: 10.1016/j.jpeds.2021.01.030. Epub 2021 Jan 21.
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Treatment for Post-hemorrhagic Ventricular Dilatation: A Multiple-Treatment Meta-Analysis.
出血后脑室扩张的治疗:一项多种治疗方法的荟萃分析。
Front Pediatr. 2020 Jun 23;8:238. doi: 10.3389/fped.2020.00238. eCollection 2020.
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Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries.11 个高收入国家中极早产和极低出生体重儿结局的变化趋势。
J Pediatr. 2019 Dec;215:32-40.e14. doi: 10.1016/j.jpeds.2019.08.020. Epub 2019 Oct 3.
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Preterm brain injury: Germinal matrix-intraventricular hemorrhage and post-hemorrhagic ventricular dilatation.早产脑损伤:生发基质-脑室内出血及出血后脑室扩张。
Handb Clin Neurol. 2019;162:173-199. doi: 10.1016/B978-0-444-64029-1.00008-4.
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Frontal Occipital and Frontal Temporal Horn Ratios: Comparison and Validation of Head Ultrasound-Derived Indexes With MRI and Ventricular Volumes in Infantile Ventriculomegaly.额枕角和额颞角比值:头超声衍生指数与 MRI 及婴儿脑室扩大的脑室容积的比较和验证。
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Posthemorrhagic ventricular dilatation in preterm infants: When best to intervene?早产儿出血后脑室扩张:何时最佳干预?
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