目的:本研究的目的是评估高级别生发基质出血-脑室内出血(GMH-IVH)早期颅超声(CUS)的体积测量是否与脑积水和神经发育指标相关。
方法:对2007年至2015年期间在圣路易斯儿童医院新生儿重症监护病房接受高级GMH-IVH的婴儿进行了回顾性病例系列分析,并使用Bayley婴儿和幼儿发育量表进行了神经发育测试。在矫正年龄2岁时进行第3版(Bayley-III)。GMH音量,脑室周围出血性梗死体积,额颞角比率是从新生儿CUS研究的直接回顾中获得的。使用单变量和多变量回归模型来评估出血量与脑积水之间的关系,这些脑积水需要进行永久性CSF改道和心室分流术或内镜下第三脑室造瘘术伴或不伴脉络丛烧灼和复合Bayley-III认知。语言,和运动分数。
结果:43名婴儿(29名男性,平均胎龄25周)符合纳入标准。最大出血量或首次诊断为最高等级的CUS时的平均年龄为6.2天。19例患者接受了永久性CSF改道的脑积水治疗。在多变量分析中,较大的GMH体积与较差的Bayley-III认知(左侧GMH体积:p=0.048,总GMH体积:p=0.023)和运动(左侧GMH体积:p=0.010;总GMH体积:p=0.014)评分相关.较大的脑室周围出血性梗死体积与较差的Bayley-III运动评分相关(每侧p<0.04)。左侧(OR2.55,95%CI1.10-5.88;p=0.028)和总(OR1.35,95%CI1.01-1.79;p=0.041)GMH体积与脑积水相关。早期心室容积与脑积水或神经发育结果之间没有关系。
结论:早期CUS的位置特异性出血量可能是高级别GMH-IVH的神经发育和脑积水结局的预后。
OBJECTIVE: The objective of this study was to evaluate whether volumetric measurements on early cranial ultrasound (CUS) in high-grade germinal matrix hemorrhage-intraventricular hemorrhage (GMH-IVH) are associated with
hydrocephalus and neurodevelopmental metrics.
METHODS: A retrospective case series analysis of infants with high-grade GMH-IVH admitted to the St. Louis Children\'s Hospital neonatal intensive care unit between 2007 and 2015 who underwent neurodevelopmental testing using the Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III) at 2 years of corrected age was performed. GMH volume, periventricular hemorrhagic infarction volume, and frontotemporal horn ratio were obtained from direct review of neonatal CUS studies. Univariate and multivariable regression models were used to evaluate the association between hemorrhage volumes and
hydrocephalus requiring permanent CSF diversion with ventricular shunt or endoscopic third ventriculostomy with or without choroid plexus cauterization and composite Bayley-III cognitive, language, and motor scores.
RESULTS: Forty-three infants (29 males, mean gestational age 25 weeks) met the inclusion criteria. The mean age at time of the CUS with the largest hemorrhage volume or first diagnosis of highest grade was 6.2 days. Nineteen patients underwent treatment for
hydrocephalus with permanent CSF diversion. In multivariable analyses, larger GMH volume was associated with worse estimated Bayley-III cognitive (left-sided GMH volume: p = 0.048, total GMH volume: p = 0.023) and motor (left-sided GMH volume: p = 0.010; total GMH volume: p = 0.014) scores. Larger periventricular hemorrhagic infarction volume was associated with worse estimated Bayley-III motor scores (each side p < 0.04). Larger left-sided (OR 2.55, 95% CI 1.10-5.88; p = 0.028) and total (OR 1.35, 95% CI 1.01-1.79; p = 0.041) GMH volumes correlated with
hydrocephalus. There was no relationship between early ventricular volume and
hydrocephalus or neurodevelopmental outcomes.
CONCLUSIONS: Location-specific hemorrhage volume on early CUS may be prognostic for neurodevelopmental and hydrocephalus outcomes in high-grade GMH-IVH.