Allan W C, Vohr B, Makuch R W, Katz K H, Ment L R
Division of Pediatric Neurology, Maine Medical Center, Portland, USA.
Arch Pediatr Adolesc Med. 1997 Jun;151(6):580-5. doi: 10.1001/archpedi.1997.02170430046010.
To determine if cerebral palsy (CP) rates were lower in the active treatment group compared with the control group, as improved survival rates of very low-birth-weight infants are postulated to be the cause of the increased incidence of CP in preterm infants, to evaluate relationships between multiple prenatal, perinatal, and postnatal variables and CP to understand better its antecedents in very low-birth-weight infants in the era of surfactant replacement therapy, and to determine the usefulness of a cranial ultrasonographic (US) scan in predicting CP.
Inception cohort follow-up study as part of a randomized controlled trial of low-dose indomethacin sodium for the prevention of intraventricular hemorrhage.
Neonatal intensive care units at 3 medical centers.
Infants with birth weights between 600 and 1250 g were eligible, and 505 infants were enrolled in the original study. Of these infants, 440 (87%) survived; neurologic examinations were completed on 381 infants (86%) at 36 months corrected age.
Statistical analyses were performed to identify the antecedents of CP, including the results of frequent cranial US scans obtained throughout the newborn period.
Cerebral palsy was found in 36 (9.5%) of 381 infants at 36 months corrected age (range, 33-39 months corrected age). Univariate analysis identified chorioamnionitis, treatment with surfactant, bronchopulmonary dysplasia, and abnormal cranial US findings as antecedents of CP. Periventricular leukomalacia and ventriculomegaly were associated with the highest detection rates for CP (37% and 30%, respectively) with acceptable false-positive rates. Multivariate analysis identified bronchopulmonary dysplasia and an abnormal cranial US scan showing grade 3 to 4 intraventricular hemorrhage, periventricular leukomalacia, or ventriculomegaly as independent predictors of CP. Odds ratios for the detection of CP using cranial US findings tabulated by hospital day were in the range of 7 to 26 beginning on day 2.
The results suggest that cranial US findings are useful predictors of CP during a patient's stay in the hospital.
鉴于极低出生体重儿存活率的提高被推测为早产儿脑瘫发病率增加的原因，确定积极治疗组的脑瘫（CP）发生率是否低于对照组；评估多个产前、围产期和产后变量与脑瘫之间的关系，以便在表面活性剂替代疗法时代更好地了解极低出生体重儿脑瘫的病因；并确定头颅超声（US）扫描在预测脑瘫方面的效用。
作为低剂量吲哚美辛钠预防脑室内出血随机对照试验一部分的起始队列随访研究。
3个医疗中心的新生儿重症监护病房。
出生体重在600至1250克之间的婴儿符合条件，最初研究纳入了505名婴儿。其中，440名（87%）存活；在矫正年龄36个月时，对381名婴儿（86%）完成了神经学检查。
进行统计分析以确定脑瘫的病因，包括整个新生儿期频繁头颅超声扫描的结果。
在矫正年龄36个月时（范围为矫正年龄33 - 39个月），381名婴儿中有36名（9.5%）被发现患有脑瘫。单因素分析确定绒毛膜羊膜炎、表面活性剂治疗、支气管肺发育不良和头颅超声检查异常结果为脑瘫的病因。脑室周围白质软化和脑室扩大与脑瘫的最高检出率相关（分别为37%和30%），假阳性率可接受。多因素分析确定支气管肺发育不良和头颅超声检查异常显示3至4级脑室内出血、脑室周围白质软化或脑室扩大为脑瘫的独立预测因素。从第2天开始，根据住院天数列出的头颅超声检查结果检测脑瘫的优势比在7至26之间。
结果表明，头颅超声检查结果是患者住院期间脑瘫的有用预测指标。
