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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >The etiology and outcome of cerebral ventriculomegaly at term in very low birth weight preterm infants.
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The etiology and outcome of cerebral ventriculomegaly at term in very low birth weight preterm infants.

机译：出生体重很低的早产儿足月的脑室扩大的病因和预后。

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BACKGROUND: Despite improvements in survival data, the incidence of neurodevelopmental handicaps in preterm infants remains high. To prevent these handicaps, one must understand the pathophysiology behind them. For preterm infants, cerebral ventriculomegaly (VM) may be associated with adverse neurodevelopmental outcome. We hypothesized that although the causes of VM are multiple, the incidence of handicap at 4.5 years of age in preterm infants with this ultrasonographic finding at term would be high. METHODS: To test this hypothesis, we provided neurodevelopmental follow-up for all 440 very low birth weight survivors of the Multicenter Randomized Indomethacin Intraventricular Hemorrhage (IVH) Prevention Trial. A total of 384 children (87%) were evaluated at 54 months' corrected age (CA), and 257 subjects were living in English-speaking, monolingual households and are included in the following data analysis. RESULTS: Moderate to severe low pressure VM at term was documented in 11 (4%) of the English-speaking, monolingual survivors. High grade IVH and bronchopulmonary dysplasia (BPD) were both risk factors for the development of VM. Of 11 (45%) children with VM, 5 suffered grades 3 to 4 IVH, compared with 2/246 (1%) children without VM who experienced grades 3 to 4 IVH. Similarly, 9/11 (82%) children with VM had BPD, compared with 120/246 (49%) children without VM who had BPD. Logistic regression analysis was performed using birth weight, gestational age, gender, Apgar score at 5 minutes, BPD, sepsis, moderate to severe VM, periventricular leukomalacia, grade of IVH, and maternal education to predict IQ <70. Although maternal education was an important and independent predictor of adverse cognitive outcome, in this series of very low birth weight prematurely born children, VM was the most important predictor of IQ <70 (OR: 19.0; 95% CI: 4.5, 80.6). Of children with VM, 6/11 (55%) had an IQ <70, compared with 31/246 (13%) of children without VM. Children with VM had significantly lower verbal and performance scores compared with children without VM. CONCLUSIONS: These data suggest that, for preterm neonates, VM at term is a consequence of the vulnerability of the developing brain. Furthermore, its presence is an important and independent predictor of adverse cognitive and motor development at 4.5 years' CA.
机译：背景：尽管生存数据有所改善，早产儿神经发育障碍的发生率仍然很高。为了预防这些障碍，必须了解其背后的病理生理。对于早产儿，脑室扩大（VM）可能与不良的神经发育结果相关。我们假设尽管VM的原因多种多样，但在足月有此超声检查结果的早产婴儿在4.5岁时出现残障的发生率会很高。方法：为了检验这一假设，我们为多中心随机消炎痛脑室内出血（IVH）预防试验的所有440名极低出生体重幸存者提供了神经发育随访。共有384名儿童（87％）在54个月的矫正年龄（CA）下接受了评估，其中257名受试者生活在说英语的单语家庭中，并包括在以下数据分析中。结果：11名（4％）会说英语的单语幸存者在足月有中度至重度低压VM。高度IVH和支气管肺发育不良（BPD）都是VM发生的危险因素。在11名（45％）患有VM的儿童中，有5名经历了3至4级IVH，而2/246（1％）没有VM的儿童经历了3至4级IVH。同样，有VM的儿童中有BPD的儿童为9/11（82％），而没有VM的儿童中有BPD的儿童为120/246（49％）。使用出生体重，胎龄，性别，5分钟的Apgar评分，BPD，脓毒症，中度至重度VM，室周白细胞软化，IVH等级和母亲教育进行智商<70预测，进行逻辑回归分析。尽管产妇教育是不良认知结果的重要且独立的预测因子，但在这一系列极低出生体重的早产儿中，VM是智商<70的最重要预测因子（OR：19.0; 95％CI：4.5、80.6）。有VM的儿童中，有6/11（55％）的智商低于70，而没有VM的儿童中有31/246（13％）。与没有VM的儿童相比，有VM的儿童的言语和表现得分明显较低。结论：这些数据表明，对于早产儿，足月VM是大脑发育中的脆弱性的结果。此外，它的存在是CA 4.5年后不良认知和运动发育的重要且独立的预测指标。

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