TY - JOUR
T1 - Outcomes Following Post-Hemorrhagic Ventricular Dilatation among Infants of Extremely Low Gestational Age
AU - Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
AU - Shankaran, Seetha
AU - Bajaj, Monika
AU - Natarajan, Girija
AU - Saha, Shampa
AU - Pappas, Athina
AU - Davis, Alexis S.
AU - Hintz, Susan R.
AU - Adams-Chapman, Ira
AU - Das, Abhik
AU - Bell, Edward F.
AU - Stoll, Barbara J.
AU - Walsh, Michele C.
AU - Laptook, Abbot R.
AU - Carlo, Waldemar A.
AU - Van Meurs, Krisa P.
AU - Sánchez, Pablo J.
AU - Ball, M. Bethany
AU - Hale, Ellen C.
AU - Seabrook, Ruth
AU - Higgins, Rosemary D.
N1 - Funding Information:
The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development ( NICHD ) provided grant support for the Neonatal Research Network's on-going Birth Registry and Follow-up Registry through cooperative agreements. There is no potential conflict of interest, real or perceived, with the study sponsor. The sponsor did not have a role in the study design, collection of data, analysis and interpretation of data, writing the report or decision to submit the manuscript for publication. The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development ( NICHD ) ( U10 HD21373 , UG1 HD21364 , UG1 HD21385 , UG1 Funding Sources: The National Institutes of Health and NICHD ( U10 HD21373 , UG1 HD21364 , UG1 HD21385 , UG1 HD27851 , UG1 HD27853 , UG1 HD27856 , UG1 HD27880 , UG1 HD27904 , UG1 HD34216 , UG1 HD36790 , UG1 HD40492 , UG1 HD40689 , UG1 HD53089 , UG1 HD53109 , UG1 HD68244 , UG1 HD68270 , UG1 HD68278 , UG1 HD68263 , UG1 HD68284 ; UG1 HD87226 , UG1 HD87229 ) and the National Center for Advancing Translational Sciences ( NCATS ) ( UL1 TR6 , UL1 TR41 , UL1 TR42 , UL1 TR77 , UL1 TR93 , UL1 TR105 , UL1 TR442 , UL1 TR454 , UL1 TR1117 , provided grant support for the Neonatal Research Network, including for the follow-up study.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/11
Y1 - 2020/11
N2 - Objective: To assess outcomes following post-hemorrhagic ventricular dilatation (PHVD) among infants born at ≤26 weeks of gestation. Study design: Observational study of infants born April 1, 2011, to December 31, 2015, in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and categorized into 3 groups: PHVD, intracranial hemorrhage without ventricular dilatation, or normal head ultrasound. PHVD was treated per center practice. Neurodevelopmental impairment at 18-26 months was defined by cerebral palsy, Bayley Scales of Infant and Toddler Development, 3rd edition, cognitive or motor score <70, blindness, or deafness. Multivariable logistic regression examined the association of death or impairment, adjusting for neonatal course, center, maternal education, and parenchymal hemorrhage. Results: Of 4216 infants, 815 had PHVD, 769 had hemorrhage without ventricular dilatation, and 2632 had normal head ultrasounds. Progressive dilatation occurred among 119 of 815 infants; the initial intervention in 66 infants was reservoir placement and 53 had ventriculoperitoneal shunt placement. Death or impairment occurred among 68%, 39%, and 28% of infants with PHVD, hemorrhage without dilatation, and normal head ultrasound, respectively; aOR (95% CI) were 4.6 (3.8-5.7) PHVD vs normal head ultrasound scan and 2.98 (2.3-3.8) for PHVD vs hemorrhage without dilatation. Death or impairment was more frequent with intervention for progressive dilatation vs no intervention (80% vs 65%; aOR 2.2 [1.38-3.8]). Death or impairment increased with parenchymal hemorrhage, intervention for PHVD, male sex, and surgery for retinopathy; odds decreased with each additional gestational week. Conclusions: PHVD was associated with high rates of death or impairment among infants with gestational ages ≤26 weeks; risk was further increased among those with progressive ventricular dilation requiring intervention.
AB - Objective: To assess outcomes following post-hemorrhagic ventricular dilatation (PHVD) among infants born at ≤26 weeks of gestation. Study design: Observational study of infants born April 1, 2011, to December 31, 2015, in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and categorized into 3 groups: PHVD, intracranial hemorrhage without ventricular dilatation, or normal head ultrasound. PHVD was treated per center practice. Neurodevelopmental impairment at 18-26 months was defined by cerebral palsy, Bayley Scales of Infant and Toddler Development, 3rd edition, cognitive or motor score <70, blindness, or deafness. Multivariable logistic regression examined the association of death or impairment, adjusting for neonatal course, center, maternal education, and parenchymal hemorrhage. Results: Of 4216 infants, 815 had PHVD, 769 had hemorrhage without ventricular dilatation, and 2632 had normal head ultrasounds. Progressive dilatation occurred among 119 of 815 infants; the initial intervention in 66 infants was reservoir placement and 53 had ventriculoperitoneal shunt placement. Death or impairment occurred among 68%, 39%, and 28% of infants with PHVD, hemorrhage without dilatation, and normal head ultrasound, respectively; aOR (95% CI) were 4.6 (3.8-5.7) PHVD vs normal head ultrasound scan and 2.98 (2.3-3.8) for PHVD vs hemorrhage without dilatation. Death or impairment was more frequent with intervention for progressive dilatation vs no intervention (80% vs 65%; aOR 2.2 [1.38-3.8]). Death or impairment increased with parenchymal hemorrhage, intervention for PHVD, male sex, and surgery for retinopathy; odds decreased with each additional gestational week. Conclusions: PHVD was associated with high rates of death or impairment among infants with gestational ages ≤26 weeks; risk was further increased among those with progressive ventricular dilation requiring intervention.
KW - extremely low gestational age infants
KW - outcome
KW - post-hemorrhagic ventricular dilatation
UR - http://www.scopus.com/inward/record.url?scp=85091001384&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2020.07.080
DO - 10.1016/j.jpeds.2020.07.080
M3 - Article
C2 - 32739261
AN - SCOPUS:85091001384
SN - 0022-3476
VL - 226
SP - 36-44.e3
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -