Biran Valérie, Groulx-Boivin Emilie, Beltempo Marc, Paquette Mariane, Khairy May, Laval Nancy, Dudley Roy, Weil Alexander, Ferrand Amaryllis, Guillot Mireille, Pinchefsky Elana, Tremblay Sophie, Garfinkle Jarred
Division of Neonatology, Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, QC, Canada.
Division of Neonatology, Robert Debré Children's Hospital, Paris-Cité University, Assistance Publique-Hôpitaux de Paris, Paris, France.
Pediatr Res. 2025 Jul 1. doi: 10.1038/s41390-025-04249-w.
To investigate the impact of maximal ventricular dilatation and age at first neurosurgical intervention on neurodevelopmental impairment among preterm newborns with post-hemorrhagic ventricular dilatation (PHVD).
Retrospective cohort study of 105 surviving newborns ≤34 weeks' gestation between 2012-2020 with PHVD. We studied the association of maximal ventricular dilatation to significant impairment at 18-months corrected-age in the overall cohort and of ventricular dilatation and timing of first neurosurgical intervention to impairment in the 51 newborns who underwent a neurosurgical intervention.
Forty-nine of 105 (47%) had significant impairment. Maximal anterior horn width (AHW) but not ventricular index was associated with significant impairment (adjusted odds ratio [aOR] 2.07, 95%CI 1.18-3.65 for AHW quintiles) after adjusting for site, GA, intraventricular hemorrhage grade, and neurosurgical intervention. In the 51 (49%) newborns that underwent neurosurgical intervention, the first neurosurgical intervention occurred at median 23 days of life (IQR 17,40). Only age >23 days at first intervention was associated with significant impairment after adjusting for AHW and GA (aOR 6.32, 95%CI 1.13-35.29).
Increasing maximal ventricular dilatation and later age at first neurosurgical intervention were associated with significant impairment in preterm PHVD survivors. Intervening promptly upon progression of severe PHVD may mitigate later impairment.
The combined impact of maximal ventricular dilatation and timing of intervention in post-hemorrhagic ventricular dilatation (PHVD) is not well-established. Greater maximal anterior horn width but not ventricular index was associated with significant impairment. In those receiving a neurosurgical intervention, later age at first intervention was associated with significant impairment. Intervening promptly upon progression of severe PHVD may mitigate later impairment.
探讨最大心室扩张及首次神经外科干预时的年龄对出血后脑室扩张（PHVD）早产儿神经发育障碍的影响。
对2012年至2020年间105例孕周≤34周且存活的PHVD新生儿进行回顾性队列研究。我们研究了整个队列中最大心室扩张与18个月矫正年龄时严重障碍之间的关联，以及51例接受神经外科干预的新生儿中心室扩张和首次神经外科干预时机与障碍之间的关联。
105例中有49例（47%）存在严重障碍。在校正了出生地点、孕周、脑室内出血分级和神经外科干预因素后，最大前角宽度（AHW）而非脑室指数与严重障碍相关（AHW五分位数的调整优势比[aOR]为2.07，95%可信区间[CI]为1.18 - 3.65）。在51例（49%）接受神经外科干预的新生儿中，首次神经外科干预发生在出生后第23天（四分位间距为17 - 40天）。在校正了AHW和孕周后，仅首次干预年龄>23天与严重障碍相关（aOR为6.32，95%CI为1.13 - 35.29）。
最大心室扩张增加及首次神经外科干预年龄较晚与PHVD早产儿幸存者的严重障碍相关。在严重PHVD进展时及时干预可能减轻后期障碍。
出血后脑室扩张（PHVD）中最大心室扩张和干预时机的联合影响尚未明确。更大的最大前角宽度而非脑室指数与严重障碍相关。在接受神经外科干预的患者中，首次干预年龄较晚与严重障碍相关。在严重PHVD进展时及时干预可能减轻后期障碍。
