目的:早产儿脑室内出血(IVH)和脑室周围白质软化(PVL)与长期神经发育障碍(NDI)和脑瘫(CP)的风险增加相关。然而,尽管越来越多的证据强调早期NDI/CP诊断的可行性和重要性,但人们对它们对早期神经发育结局的影响知之甚少.我们旨在确定IVH和PVL早产儿的早期神经发育结局。
方法:这是一项回顾性的单中心队列研究,研究对象是妊娠<29周或出生体重<1000g,在矫正年龄3~4个月时参加早期神经发育诊所的早产儿。在没有IVH的婴儿和轻度IVH(I-II级)的婴儿之间,比较了基于Prechtl的一般运动评估和Hammersmith婴儿神经系统检查的早期NDI和CP/高危CP诊断的主要结果。严重的IVH(III-IV级),和严重脑损伤(SBI;严重IVH或囊性PVL)。
结果:在313名婴儿中,52.1%(n=163),41.2%(n=129),6.7%(n=21)和8.6%(n=27)没有IVH,轻度IVH,严重的IVH和SBI,分别。重度IVH(aOR6.07,95%CI1.50-24.50)和SBI(aOR15.28,95%CI3.70-63)的婴儿中,早期CP/高风险CP诊断的校正几率明显更高,但不适用于轻度IVH患者(aOR1.24,95%CI0.49-3.10)。然而,任何早期NDI的校正后几率在各组间相似.
结论:患有严重IVH和SBI的早产儿在校正年龄3至4个月时早期CP/CP诊断高风险增加。
OBJECTIVE: Intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL) in preterm infants are associated with an increased risk of long-term neurodevelopmental impairments (NDI) and cerebral palsy (CP). However, little is known about their impact on early neurodevelopmental outcomes despite increasing evidence highlighting the feasibility and importance of early NDI/CP diagnosis. We aimed to determine the early neurodevelopmental outcomes of preterm infants with IVH and PVL.
METHODS: This was a retrospective single-centre cohort study of preterm infants born at <29 weeks gestation or <1000 g birth weight who attended an Early Neurodevelopment Clinic at 3 to 4 months of corrected age. Primary outcomes of early NDI and CP/high-risk CP diagnoses based on Prechtl\'s General Movements Assessment and the Hammersmith Infant Neurological Examination were compared between infants without IVH and infants with mild IVH (grades I-II), severe IVH (grades III-IV), and severe brain injury (SBI; severe IVH or cystic PVL).
RESULTS: Of 313 infants, 52.1% (n = 163), 41.2% (n = 129), 6.7% (n = 21) and 8.6% (n = 27) had no IVH, mild IVH, severe IVH and SBI, respectively. The adjusted odds of early CP/high-risk CP diagnosis were significantly higher in infants with severe IVH (aOR 6.07, 95% CI 1.50-24.50) and SBI (aOR 15.28, 95% CI 3.70-63), but not in those with mild IVH (aOR 1.24, 95% CI 0.49-3.10). However, the adjusted odds of any early NDI were similar across groups.
CONCLUSIONS: Preterm infants with severe IVH and SBI are at increased risk of early CP/high-risk of CP diagnosis at 3 to 4 months of corrected age.