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Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage.

Publication ,  Journal Article
Pappas, A; Adams-Chapman, I; Shankaran, S; McDonald, SA; Stoll, BJ; Laptook, AR; Carlo, WA; Van Meurs, KP; Hintz, SR; Carlson, MD; Walsh, MC ...
Published in: JAMA Pediatr
January 1, 2018

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 study was 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 outcome was 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: Of 4193 neonates with ultrasonography data, 300 had nonhemorrhagic ventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomes were available for 3008 of 3345 neonates with ventriculomegaly or normal scans (90%). Compared with normal cranial ultrasonograms, ventriculomegaly was 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/neurodevelopmental impairment (OR, 2.17; 95% CI, 1.62-2.91), but not death alone (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.

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Published In

JAMA Pediatr

DOI

EISSN

2168-6211

Publication Date

January 1, 2018

Volume

172

Issue

1

Start / End Page

32 / 42

Location

United States

Related Subject Headings

  • Ultrasonography
  • Retrospective Studies
  • Prognosis
  • Neurodevelopmental Disorders
  • Male
  • Longitudinal Studies
  • Infant, Premature, Diseases
  • Infant, Newborn
  • Infant, Extremely Premature
  • Hydrocephalus
 

Citation

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Pappas, A., Adams-Chapman, I., Shankaran, S., McDonald, S. A., Stoll, B. J., Laptook, A. R., … Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, . (2018). Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage. JAMA Pediatr, 172(1), 32–42. https://doi.org/10.1001/jamapediatrics.2017.3545
Pappas, Athina, Ira Adams-Chapman, Seetha Shankaran, Scott A. McDonald, Barbara J. Stoll, Abbot R. Laptook, Waldemar A. Carlo, et al. “Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage.JAMA Pediatr 172, no. 1 (January 1, 2018): 32–42. https://doi.org/10.1001/jamapediatrics.2017.3545.
Pappas A, Adams-Chapman I, Shankaran S, McDonald SA, Stoll BJ, Laptook AR, et al. Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage. JAMA Pediatr. 2018 Jan 1;172(1):32–42.
Pappas, Athina, et al. “Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage.JAMA Pediatr, vol. 172, no. 1, Jan. 2018, pp. 32–42. Pubmed, doi:10.1001/jamapediatrics.2017.3545.
Pappas A, Adams-Chapman I, Shankaran S, McDonald SA, Stoll BJ, Laptook AR, Carlo WA, Van Meurs KP, Hintz SR, Carlson MD, Brumbaugh JE, Walsh MC, Wyckoff MH, Das A, Higgins RD, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and Behavioral Outcomes in Extremely Premature Neonates With Ventriculomegaly in the Absence of Periventricular-Intraventricular Hemorrhage. JAMA Pediatr. 2018 Jan 1;172(1):32–42.

Published In

JAMA Pediatr

DOI

EISSN

2168-6211

Publication Date

January 1, 2018

Volume

172

Issue

1

Start / End Page

32 / 42

Location

United States

Related Subject Headings

  • Ultrasonography
  • Retrospective Studies
  • Prognosis
  • Neurodevelopmental Disorders
  • Male
  • Longitudinal Studies
  • Infant, Premature, Diseases
  • Infant, Newborn
  • Infant, Extremely Premature
  • Hydrocephalus