Relationship of cerebral intraventricular hemorrhage and early childhood neurologic handicaps

doi:10.1016/S0022-3476(83)80366-7

The Journal of Pediatrics

Volume 103, Issue 2, August 1983, Pages 273-277

https://doi.org/10.1016/S0022-3476(83)80366-7 Get rights and content

The outcome in 198 surviving very-low-birth-weight (<1501 gm) infants with and without cerebral intraventricular hemorrhage was compared to determine whether CVH is associated with early childhood developmental or nerromotor handicaps. Major handicaps were noted in 10% of the infants without and 28% of the infants with CVH. Among the infants with CVH, a major handicap was present in 9% with grade 1, 11% with grade 2, 36% with grade 3, and 76% with grade 4 CVH. Infants with posthemorrhagic hydrocephalus had the same incidence of major handicaps (59%) as did comparable infants with no hydrocephalus (57%). Our data indicate that grades 1 and 2 CVH do not increase an infant's risk for major handicaps, and there is a direct relationship of grades 3 and 4 CVH and major handicaps.

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Cord blood granulocyte Colony-Stimulating factor level as an optimal predictor of umbilical cord arteritis associated with brain injury at term equivalent age in preterm neonates
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The study aimed 1) to evaluate the association between the presence or absence of umbilical cord arteritis (UCA) and the cord blood cytokine levels, and 2) morbidity and mortality of preterm neonates; and 3) to identify predictive markers for UCA of preterm neonates.
In this single-center retrospective observational cohort study, preterm neonates born at gestational age (GA) < 36 weeks were categorized pathologically according to the severity of intrauterine inflammation; those without UCA as Group 1, those with UCA as Group 2, and those without any intrauterine inflammation as Group 3 (control), and subgroup analyses classified by their GA were performed. We compared morbidity and mortality, and eight representative cytokine levels in cord blood samples between the groups. Subsequently, receiver operating characteristics (ROC) curves for UCA diagnosis for each cytokine were created, and values of areas under the curve (AUC) were calculated to determine the optimal predictive markers.
In total, 105 patients (36, 58, and 11 in Groups 1, 2, and 3, respectively) were included. Multivariate logistic analysis revealed that patients with UCA had higher incidence of brain injury (Odds Ratio [OR] = 8.53, P = 0.0049, 95% Confidence Interval [CI]: 1.91 – 38.0), at term equivalent age in the subgroup analysis with GA < 32 weeks. Although the median value of cord blood granulocyte colony-stimulating factor (G-CSF) was significantly higher in Group 2 than in Group 1 or 3, only the G-CSF level was found to be high in the subgroup analysis with GA < 32 weeks. For UCA diagnosis, the AUC values of G-CSF were the highest among eight cytokines including interleukin 6 (IL-6). These findings were similar in the subgroup analysis with GA < 32 weeks.
Preterm neonates, especially born at GA < 32 week, had higher morbidity from　brain injury in the group with UCA. The cord blood G-CSF level was highly accurate for predicting UCA and could thus be used as an optimal biomarker.
Preterm-related posthemorrhagic hydrocephalus: Review of our institutional series with a long-term follow-up
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Preterm-related posthemorrhagic hydrocephalus is a major cause of neurological impairment and a common indication for a ventriculoperitoneal shunt in infants that are prone to diverse complications. Protocols of diagnosis and treatment are in continuous evolution and require evaluation of their results.
To review the clinical characteristics and results of a series of preterm-related posthemorrhagic hydrocephalus needing a definitive shunt from 1982 to 2020 in our institution. As a secondary objective we evaluated the safety of the changes in our protocol of treatment from 2015.
Retrospective review, clinical investigation.
133 patients were implanted a shunt in the study period. Shunt infection was diagnosed in 15 patients. Proximal shunt obstruction as the first complication was diagnosed in 30% of cases at one year, 37% at two years and 46% at five years. 61 patients developed very small or collapsed ventricles at last follow-up. Two thirds of our patients achieved normal neurological development or mild impairment. Changes in protocol did not significantly modify clinical results although improvement in most outcomes was observed. Mean follow-up was over nine years.
Clinical outcomes are comparable to previous reported data. Changes in protocol proved to be safe and improved our results. Programmable shunts can be used safely in preterm patients although they may not prevent tendency towards ventricular collapse, which is very common after long follow-up.
La hidrocefalia poshemorrágica del prematuro continúa siendo una causa importante de lesión cerebral perinatal y una indicación frecuente de cirugía derivativa valvular en un grupo de pacientes particularmente vulnerable y expuesto a complicaciones. Los protocolos de diagnóstico y tratamiento están en continua evolución y requieren un análisis de los resultados asociados a ellos.
Revisar las características clínicas y los resultados de tratamiento en una serie de prematuros con hidrocefalia poshemorrágica en los que se implantó una derivación ventriculoperitoneal permanente en nuestro hospital entre 1982 y 2000. Como objetivo secundario evaluamos la seguridad de los cambios introducidos en nuestro protocolo desde 2015.
Estudio clínico retrospectivo, serie de casos.
133 prematuros requirieron una derivación ventriculoperitoneal permanente en el tiempo de estudio. En 15 de ellos se diagnosticó una infección del sistema de derivación. La obstrucción proximal de la derivación como primera complicación posquirúrgica ocurrió en un 30% de los pacientes al primer año, en el 37% de los pacientes a los dos años y en el 46% de los casos a los 5 años de seguimiento. 61 pacientes desarrollaron un colapso ventricular clínico o radiológico. Dos tercios de los pacientes presentaron un desarrollo psicomotor normal o un retraso de carácter leve. Los cambios incorporados en nuestro protocolo de tratamiento no modificaron la evolución clínica significativamente, aunque se asociaron a una evolución globalmente más favorable. La media de seguimiento fue superior a los 9 años.
Los resultados clínicos presentados se encuentran en línea con las series publicadas, Los cambios incorporados en nuestro protocolo actualizado demostraron ser seguros y pueden asociarse a una evolución más favorable. Los sistemas de derivación programable pueden ser empleados con seguridad en pacientes prematuros si bien no evitan de forma aislada el desarrollo del colapso ventricular, el cual es extraordinariamente frecuente a medida que se prolongan los tiempos de seguimiento.
Delayed Surgical Closure of the Patent Ductus Arteriosus: Does the Brain Pay the Price?
2023, Journal of Pediatrics
Citation Excerpt :
Cranial ultrasound studies were performed based on the guidelines used in our NICU, including before and within 24 hours after surgery (or more frequently where appropriate). Periventricular/intraventricular hemorrhage (PIVH) was categorized as mild if grade 2 or less and moderate-to-severe if grade 3 or 4 (according to grading of Papile et al).26 We monitored near infrared spectroscopy–determined rScO2 as an estimator of substantial changes in regional cerebral oxygenation and cerebral perfusion27-29 in all infants born preterm with a gestational age <30 weeks during the first 3 days of life or longer in case of complications such as PDA.
To investigate the relation between duration of hemodynamically significant patent ductus arteriosus (PDA), cerebral oxygenation, magnetic resonance imaging–determined brain growth, and 2-year neurodevelopmental outcome in a cohort of infants born preterm whose duct was closed surgically.
Infants born preterm at <30 weeks of gestational age who underwent surgical ductal closure between 2008 and 2018 (n = 106) were included in this observational study. Near infrared spectroscopy–monitored cerebral oxygen saturation during and up to 24 hours after ductal closure and a Bayley III developmental test at the corrected age of 2 years is the institutional standard of care for this patient group. Infants also had magnetic resonance imaging at term-equivalent age.
In total, 90 infants fulfilled the inclusion criteria (median [range]: 25.9 weeks [24.0-28.9]; 856 g [540-1350]. Days of a PDA ranged from 1 to 41. Multivariable linear regression analysis showed that duration of a PDA negatively influenced cerebellar growth and motor and cognitive outcome at 2 years of corrected age.
Prolonged duration of a PDA in this surgical cohort is associated with reduced cerebellar growth and suboptimal neurodevelopmental outcome.
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Neonatal acute respiratory distress syndrome (NARDS) was defined in 2017 and the epidemiological data remain unknown. Our objective was to explore aetiological factors, clinical characteristics and outcomes in patients with perinatal NARDS.
A multicentre, prospective, cross-sectional study was performed in 58 tertiary neonatal intensive care units in China from Jan 1, 2018 to June 30, 2019. Neonates diagnosed with NARDS were included. Primary outcomes were aetiological factors, clinical characteristics and outcomes. Binary logistic regression and multivariate cox proportional regression were performed to identify independent predictors for bronchopulmonary dysplasia (BPD) and/or death or single death. This study was registered with ClinicalTrials.Gov, NCT03311165.
Among 70,013 admitted neonates, the incidence of NARDS was 1.44% (1005). The cumulative incidences were 65.6%, 86.7%, 94.1% within one, two and three days after birth. The median gestational age and birth weight were 36.4 weeks and 2700 g. Three main aetiological triggers included pneumonia (58.1%), asphyxia (24.3%) and early-onset sepsis (EOS) (21.3%). BPD and/or death was observed in 213 (21.2%) infants, consisting 104 (10.3%) BPD and 126 (12.6%) deaths. The numbers of mild, moderate and severe NARDS were 537 (53.4%), 286 (28.4%) and 182 (18.2%). Two or more doses of surfactant was associated with increased mortality as compared with one or less doses of surfactant (odds ratio [OR] 1.93, 95% confidence interval [CI] 1.20–3.10, P = 0.006). Similarity also appeared in the comparison between EOS and non-EOS triggers (OR 1.57, 95% CI 1.06–2.33, P = 0.023).
NARDS incidence was 1.44% and the three main aetiologies were pneumonia, asphyxia and EOS. The cumulative incidences were 65.6%, 86.7%, and 94.1% within one, two and three days after birth. Our results suggested that two or more doses of surfactant increased mortality compared with one or less doses of surfactant.
The National Clinical Research Center of China and Clinical Medical Study Program of Children's Hospital of Chongqing Medical University (NCRC-2019-GP-13) and Natural Science Foundation of Chongqing (cstc2020jcyj-msxmX0197).
Neonatal Cranial Ultrasound Findings among Infants Born Extremely Preterm: Associations with Neurodevelopmental Outcomes at 10 Years of Age
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To examine the association between neonatal cranial ultrasound (CUS) abnormalities among infants born extremely preterm and neurodevelopmental outcomes at 10 years of age.
In a multicenter birth cohort of infants born at <28 weeks of gestation, 889 of 1198 survivors were evaluated for neurologic, cognitive, and behavioral outcomes at 10 years of age. Sonographic markers of white matter damage (WMD) included echolucencies in the brain parenchyma and moderate to severe ventricular enlargement. Neonatal CUS findings were classified as intraventricular hemorrhage (IVH) without WMD, IVH with WMD, WMD without IVH, and neither IVH nor WMD.
WMD without IVH was associated with an increased risk of cognitive impairment (OR 3.5, 95% CI 1.7, 7.4), cerebral palsy (OR 14.3, 95% CI 6.5, 31.5), and epilepsy (OR 6.9; 95% CI 2.9, 16.8). Similar associations were found for WMD accompanied by IVH. Isolated IVH was not significantly associated these outcomes.
Among children born extremely preterm, CUS abnormalities, particularly those indicative of WMD, are predictive of neurodevelopmental impairments at 10 years of age. The strongest associations were found with cerebral palsy.
A nomogram for predicting death for infants born at a gestational age of <28 weeks: a population-based analysis in 18 neonatal intensive care units in northern China
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^†: Supported in part by the Thrasher Research Fund.

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Relationship of cerebral intraventricular hemorrhage and early childhood neurologic handicaps†

J Pediatr

J Pediatr

J Pediatr

J Pediatr

Central nervous system damage in the human fetus and newborn infant

Am J Dis Child

IVH: Incidence and outcome

Ann Neurol

Real-time ultrasonography of neonatal intraventricular hemorrhage and comparison with computed tomography

Radiology

Intracranial hemorrhage in premature infants: Accuracy of sonography evaluation

AJR

Detection of neonatal intracranial hemorrhage utilizing real-time and static ultrasound

J Clin Ultrasound

Intracranial hemorrhage in premature infants: Sonographic-pathologic correlation

AJNR

Neurologic sequelae in the survivors of neonatal intraventricular hemorrhage

Pediatrics