Abstract
IMPORTANCE Studies of cranial ultrasonography and early childhood outcomes among cohorts of extremely preterm neonates have linked periventricular-intraventricular hemorrhage and cystic periventricular leukomalacia with adverse neurodevelopmental outcomes. However, the association between nonhemorrhagic ventriculomegaly and neurodevelopmental and behavioral outcomes is not fully understood. OBJECTIVE To characterize the outcomes of extremely preterm neonates younger than 27 weeks' gestational age who experienced nonhemorrhagic ventriculomegaly that was detected prior to 36 weeks' postmenstrual age. DESIGN, SETTING, AND PARTICIPANTS This longitudinal observational studywas conducted at 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants born prior to 27 weeks' gestational age in any network facility between July 1, 2006, and June 30, 2011, were included if they had a cranial ultrasonogram performed prior to 36 weeks' postmenstrual age. Comparisons were made between those with ventriculomegaly and those with normal cranial sonograms. Data analysis was completed from August 2013 to August 2017. MAIN OUTCOMES AND MEASURES The main outcomewas neurodevelopmental impairment, defined as a Bayley Scales of Infant and Toddler Development III cognitive score less than 70, moderate/severe cerebral palsy, a Gross Motor Function Classification System score of level 2 or more, vision impairment, or hearing impairment. Secondary outcomes included Bayley Scales of Infant and Toddler Development III subscores, components of neurodevelopmental impairment, behavioral outcomes, and death/neurodevelopmental impairment. Logistic regression was used to evaluate the association of ventriculomegaly with adverse outcomes while controlling for potentially confounding variables and center differences as a random effect. Linear regression was used similarly for continuous outcomes. RESULTS Of4193neonateswithultrasonographydata,300hadnonhemorrhagicventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomeswere available for3008of3345neonateswithventriculomegaly ornormalscans(90%).Comparedwith normal cranial ultrasonograms, ventriculomegalywas associated with lower gestational age, male sex, and bronchopulmonary dysplasia, late-onset sepsis, meningitis, necrotizing enterocolitis, and stage 3 retinopathy of prematurity. After adjustment, neonates with ventriculomegaly had higher odds of neurodevelopmental impairment (odds ratio [OR], 3.07; 95%CI, 2.13-4.43), cognitive impairment (OR, 3.23; 95%CI, 2.09-4.99), moderate/severe cerebral palsy (OR, 3.68; 95%CI, 2.08-6.51),death/neurodevelopmentalimpairment(OR,2.17;95%CI,1.62-2.91),butnotdeathalone (OR, 1.09; 95%CI,0.76-1.57). Behavioral outcomes did not differ. CONCLUSIONS AND RELEVANCE Nonhemorrhagic ventriculomegaly is associated with increased odds of neurodevelopmental impairment among extremely preterm neonates.
| Original language | English |
|---|---|
| Pages (from-to) | 32-42 |
| Number of pages | 11 |
| Journal | JAMA Pediatrics |
| Volume | 172 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 2018 |
Bibliographical note
Funding Information:Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources (via General Clinical Research Center, or GCRC, grants), and the National Center for Advancing Translational Sciences (NCATS) provided grant support for generic database and follow-up studies of the Neonatal Research Network through cooperative agreements to the following institutions: Alpert Medical School of Brown University and Women and Infants Hospital of Rhode Island (NICHD grant U10 HD27904); Case Western Reserve University and Rainbow Babies and Children's Hospital (U10 HD21364, GCRC grant M01 RR80), Children's Mercy Hospital (U10 HD68284), Cincinnati Children's Hospital Medical Center, University Hospital, and Good Samaritan Hospital (U10 HD27853, GCRC grant M01 RR8084); Duke University School of Medicine, University Hospital, University of North Carolina, and Duke Regional Hospital (U10 HD40492, M01 RR30, NCATS grant UL1 TR83); Emory University, Children’s Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown (U10 HD27851, M01 RR39, UL1 TR454); Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children, and Wishard Health Services (U10 HD27856, M01 RR750, UL1 TR6); Nationwide Children’s Hospital and the Ohio State University Medical Center (U10 HD68278); RTI International (U10 HD36790); Stanford University, Dominican Hospital, El Camino Hospital, and Lucile Packard Children's Hospital (U10 HD27880, M01 RR70, UL1 TR93); Tufts Medical Center, Floating Hospital for Children (U10 HD53119, M01 RR54); University of Alabama at Birmingham Health System and Children’s Hospital of Alabama (U10 HD34216, M01 RR32); University of California, Los Angeles, Mattel Children's Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, and Olive View Medical Center (U10 HD68270); University of California, San Diego Medical Center and Sharp Mary Birch Hospital for Women and Newborns (U10 HD40461); University of Iowa and Mercy Medical Center (U10 HD53109, M01 RR59); University of Miami, Holtz Children's Hospital (U10 HD21397, M01 RR16587); University of New Mexico Health Sciences Center (U10 HD53089, M01 RR997, UL1 TR41); University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Children's Hospital of Philadelphia (U10 HD68244); University of Rochester Medical Center, Golisano Children's Hospital, the University of Buffalo Women's, and Children's Hospital of Buffalo (U10 HD68263, U10 HD40521, UL1 RR24160, M01 RR44, UL1 TR42); University of Texas Health Science Center at Houston Medical School, Children's Memorial Hermann Hospital, and Lyndon Baines Johnson General Hospital/Harris County Hospital District (U10 HD21373); University of Texas Southwestern Medical Center at Dallas, Parkland Health and Hospital System, and Children's Medical Center Dallas (U10 HD40689, M01 RR633); University of Utah Medical Center, Intermountain Medical Center, LDS Hospital, and Primary Children's Medical Center (U10 HD53124, M01 RR64, UL1 TR105); Wake Forest University, Baptist Medical Center, Forsyth Medical Center, and Brenner Children’s Hospital (U10 HD40498, M01 RR7122); Wayne State University, Hutzel Women’s Hospital, and Children’s Hospital of Michigan (U10 HD21385); and Yale University, Yale-New Haven Children’s Hospital, and Bridgeport Hospital (U10 HD27871, UL1 RR24139, M01 RR125, UL1 TR142).
Funding Information:
The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Center for Research Resources (via General Clinical Research Center, or GCRC, grants), and the National Center for Advancing Translational Sciences (NCATS) provided grant support for generic database and follow-up studies of the Neonatal Research Network through cooperative agreements to the following institutions: Alpert Medical School of Brown University andWomen and Infants Hospital of Rhode Island (NICHD grant U10 HD27904); Case Western Reserve University and Rainbow Babies and Children's Hospital (U10 HD21364, GCRC grant M01 RR80), Children's Mercy Hospital (U10 HD68284), Cincinnati Children's Hospital Medical Center, University Hospital, and Good Samaritan Hospital (U10 HD27853, GCRC grant M01 RR8084); Duke University School of Medicine, University Hospital, University of North Carolina, and Duke Regional Hospital (U10 HD40492,M01 RR30, NCATS grant UL1 TR83); Emory University, Children's Healthcare of Atlanta, Grady Memorial Hospital, and Emory University Hospital Midtown (U10 HD27851, M01 RR39, UL1 TR454); Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children, and Wishard Health Services (U10 HD27856,M01 RR750, UL1 TR6); Nationwide Children's Hospital and the Ohio State University Medical Center (U10 HD68278); RTI International (U10 HD36790); Stanford University, Dominican Hospital, El Camino Hospital, and Lucile Packard Children's Hospital (U10 HD27880,M01 RR70, UL1 TR93); Tufts Medical Center, Floating Hospital for Children (U10 HD53119,M01 RR54); University of Alabama at Birmingham Health System and Children's Hospital of Alabama (U10 HD34216,M01 RR32); University of California, Los Angeles, Mattel Children's Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, and Olive View Medical Center (U10 HD68270); University of California, San Diego Medical Center and Sharp Mary Birch Hospital forWomen and Newborns (U10 HD40461); University of Iowa and Mercy Medical Center (U10 HD53109, M01 RR59); University of Miami, Holtz Children's Hospital (U10 HD21397,M01 RR16587); University of New Mexico Health Sciences Center (U10 HD53089, M01 RR997, UL1 TR41); University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, and Children's Hospital of Philadelphia (U10 HD68244); University of Rochester Medical Center, Golisano Children's Hospital, the University of BuffaloWomen's, and Children's Hospital of Buffalo (U10 HD68263, U10 HD40521, UL1 RR24160,M01 RR44, UL1 TR42); University of Texas Health Science Center at Houston Medical School, Children's Memorial Hermann Hospital, and Lyndon Baines Johnson General Hospital/Harris County Hospital District (U10 HD21373); University of Texas Southwestern Medical Center at Dallas, Parkland Health and Hospital System, and Children's Medical Center Dallas (U10 HD40689, M01 RR633); University of Utah Medical Center, Intermountain Medical Center, LDS Hospital, and Primary Children's Medical Center (U10 HD53124, M01 RR64, UL1 TR105);Wake Forest University, Baptist Medical Center, Forsyth Medical Center, and Brenner Children's Hospital (U10 HD40498,M01 RR7122); Wayne State University, HutzelWomen's Hospital, and Children's Hospital of Michigan (U10 HD21385); and Yale University, Yale-New Haven Children's Hospital, and Bridgeport Hospital (U10 HD27871, UL1 RR24139,M01 RR125, UL1 TR142).
Publisher Copyright:
© 2017 American Medical Association. All rights reserved.
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
