Division of Neonatology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada.
Pediatr Neurol. 2024 Oct;159:4-11. doi: 10.1016/j.pediatrneurol.2024.07.005. Epub 2024 Jul 11.
Posthemorrhagic ventricular dilatation (PHVD) is a major complication of intraventricular hemorrhage (IVH); it is associated with high risks of cerebral palsy and cognitive deficits compared with infants without PHVD. This study aims to explore the early perinatal risk factors-associated with the risk of progressive PHVD.
Neonates ≤29 weeks gestational age (GA) with Grade II-III IVH and periventricular hemorrhagic infarct (PVHI) between 2015 and 2021 were retrospectively reviewed. All cranial ultrasounds done within 14 days postnatal age (PNA) were assessed for grade of IVH, anterior horn width (AHW), ventricular index (VI), and thalamo-occipital index (TOD). The outcome was defined as death of any cause or VI and/or AHW and/or TOD ≥ moderate-risk zone based on an ultrasound done beyond two weeks PNA.
A total of 146 infants with a mean GA of 26 ± 1.8 weeks, birth weight 900 ± 234 g were included, 46% were females. The primary outcome occurred in 56 (39%) infants; among them 17 (30%) and 11 (20%) needed ventricular reservoir and shunt insertion, respectively. The risk factors present within 14 days PNA that significantly increased the odds of developing PHVD were hemodynamically significant patent ductus arteriosus (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.9 to 22), culture-proven sepsis (OR 5.4, 95% CI 1.8 to 18), Grade III IVH (OR 4.6, 95% CI 1.1 to 22), PVHI (OR 3.0, 95% CI 0.9 to 10), and VI (OR 2.1, 95% CI 1.6 to 2.9).
Clinical predictors such as significant ductus arteriosus and bacterial septicemia, along with risk levels of AHW and VI measured with early cranial ultrasounds, are potential predictors of subsequent onset of PHVD.
脑室内出血（IVH）后出现的脑室扩张（PHVD）是一种主要的并发症；与没有 PHVD 的婴儿相比，它与脑瘫和认知缺陷的风险增加有关。本研究旨在探讨与进行性 PHVD 风险相关的围产期早期危险因素。
回顾性分析 2015 年至 2021 年期间，胎龄（GA）≤29 周、存在 II-III 级 IVH 和（或）室周出血性梗死（PVHI）的新生儿。所有新生儿均在生后 14 天内进行头颅超声检查，以评估 IVH 分级、前角宽度（AHW）、脑室指数（VI）和丘脑枕指数（TOD）。根据生后两周以上的超声检查，将结局定义为任何原因导致的死亡，或 VI 和（或）AHW 和（或）TOD 达到中危区。
共有 146 例 GA 为 26±1.8 周、出生体重 900±234 g 的婴儿纳入研究，其中 46%为女性。主要结局发生在 56 例（39%）婴儿中；其中 17 例（30%）和 11 例（20%）需要脑室造瘘和分流术。生后 14 天内出现的以下危险因素显著增加了发生 PHVD 的几率：有血流动力学意义的动脉导管未闭（OR 6.1，95%CI 1.9 至 22）、培养阳性败血症（OR 5.4，95%CI 1.8 至 18）、III 级 IVH（OR 4.6，95%CI 1.1 至 22）、PVHI（OR 3.0，95%CI 0.9 至 10）和 VI（OR 2.1，95%CI 1.6 至 2.9）。
临床预测因子，如动脉导管未闭和细菌性败血症，以及早期头颅超声测量的 AHW 和 VI 风险水平，是随后发生 PHVD 的潜在预测因子。
