RESUMEN

OBJECTIVE: To assess outcomes following post-hemorrhagic ventricular dilatation (PHVD) among infants born at ≤26 weeks of gestation. STUDY DESIGN: Observational study of infants born April 1, 2011, to December 31, 2015, in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network and categorized into 3 groups: PHVD, intracranial hemorrhage without ventricular dilatation, or normal head ultrasound. PHVD was treated per center practice. Neurodevelopmental impairment at 18-26 months was defined by cerebral palsy, Bayley Scales of Infant and Toddler Development, 3rd edition, cognitive or motor score <70, blindness, or deafness. Multivariable logistic regression examined the association of death or impairment, adjusting for neonatal course, center, maternal education, and parenchymal hemorrhage. RESULTS: Of 4216 infants, 815 had PHVD, 769 had hemorrhage without ventricular dilatation, and 2632 had normal head ultrasounds. Progressive dilatation occurred among 119 of 815 infants; the initial intervention in 66 infants was reservoir placement and 53 had ventriculoperitoneal shunt placement. Death or impairment occurred among 68%, 39%, and 28% of infants with PHVD, hemorrhage without dilatation, and normal head ultrasound, respectively; aOR (95% CI) were 4.6 (3.8-5.7) PHVD vs normal head ultrasound scan and 2.98 (2.3-3.8) for PHVD vs hemorrhage without dilatation. Death or impairment was more frequent with intervention for progressive dilatation vs no intervention (80% vs 65%; aOR 2.2 [1.38-3.8]). Death or impairment increased with parenchymal hemorrhage, intervention for PHVD, male sex, and surgery for retinopathy; odds decreased with each additional gestational week. CONCLUSIONS: PHVD was associated with high rates of death or impairment among infants with gestational ages ≤26 weeks; risk was further increased among those with progressive ventricular dilation requiring intervention.

Asunto(s)

Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/mortalidad , Ventrículos Cerebrales/patología , Enfermedades del Prematuro/mortalidad , Enfermedades del Prematuro/patología , Trastornos del Neurodesarrollo/epidemiología , Hemorragia Cerebral/terapia , Dilatación Patológica , Femenino , Edad Gestacional , Humanos , Recien Nacido Extremadamente Prematuro , Recién Nacido , Enfermedades del Prematuro/terapia , Masculino , Derivación Ventriculoperitoneal

RESUMEN

OBJECTIVE: To describe the sonographic characteristics of periventricular hemorrhagic infarction (PVHI) and their association with mortality and neurodevelopmental disability in very preterm infants born in 2008-2013. STUDY DESIGN: Retrospective multicenter observational cohort study. Diagonal PVHI size was measured and severity score assessed. PVHI characteristics were scored and temporal trends were assessed. Neurodevelopmental outcome at 2 years of corrected age was assessed using either the Bayley Scales of Infant and Toddler Development, Third Edition or the Griffiths Mental Development Scales. Multigroup analyses were applied as appropriate. RESULTS: We enrolled 160 infants with median gestational age of 26.6 weeks. PVHI was mostly unilateral (90%), associated with an ipsilateral grade III intraventricular hemorrhage (84%), and located in the parietal lobe (51%). Sixty-four (40%) infants with PVHI died in the neonatal period. Of the survivors assessed at 2 years of corrected age, 65% had normal cognitive and 69% had normal motor outcomes. The cerebral palsy rate was 42%. The composite outcome of death or severe neurodevelopmental disability was observed in 58%, with no trends over the study period (P = .6). Increasing PVHI severity score was associated with death (P < .001). Increasing PVHI size and severity score were negatively associated with gross motor scores (P = .01 and .03, respectively). Trigone involvement was associated with cerebral palsy (41% vs 14%; P = .004). Associated posthemorrhagic ventricular dilation (36%) was an independent risk factor for poorer cognitive and motor outcomes (P < .001 for both). CONCLUSIONS: Increasing PVHI size and severity score were predictive of less optimal gross motor outcome and death in very preterm infants.

Asunto(s)

Hemorragia Cerebral/diagnóstico por imagen , Infarto Cerebral/diagnóstico por imagen , Ventrículos Cerebrales/diagnóstico por imagen , Enfermedades del Prematuro/diagnóstico por imagen , Hemorragia Cerebral/mortalidad , Hemorragia Cerebral/patología , Infarto Cerebral/mortalidad , Infarto Cerebral/patología , Parálisis Cerebral/complicaciones , Ventrículos Cerebrales/patología , Preescolar , Discapacidades del Desarrollo/complicaciones , Discapacidades del Desarrollo/diagnóstico por imagen , Femenino , Edad Gestacional , Humanos , Lactante , Recien Nacido Extremadamente Prematuro , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/mortalidad , Enfermedades del Prematuro/patología , Masculino , Estudios Retrospectivos , Ultrasonografía

RESUMEN

OBJECTIVES: To determine the functional network organization of the brain in infants born very preterm at term-equivalent age and to relate network alterations to known clinical risk factors for poor neurologic outcomes in prematurity. STUDY DESIGN: Resting-state functional magnetic resonance imaging data from 66 infants born very preterm (gestational age <32 weeks and birth weight <1500 g) and 66 healthy neonates born at full term, acquired as part of a prospective, cross-sectional study, were compared at term age using graph theory. Features of resting-state networks, including integration, segregation, and modularity, were derived from correlated hemodynamic activity arising from 93 cortical and subcortical regions of interest and compared between groups. RESULTS: Despite preserved small-world topology and modular organization, resting-state networks of infants born very preterm at term-equivalent age were less segregated and less integrated than those of infants born full term. Chronic respiratory illness (ie, bronchopulmonary dysplasia and the length of oxygen support) was associated with decreased global efficiency and increased path lengths (P < .05). In both cohorts, 4 functional modules with similar composition were observed (parietal/temporal, frontal, subcortical/limbic, and occipital). The density of connections in 3 of the 4 modules was decreased in the very preterm network (P < .01); however, in the occipital/visual cortex module, connectivity was increased in infants born very preterm relative to control infants (P < .0001). CONCLUSIONS: Early exposure to the ex utero environment is associated with altered resting-state network functional organization in infants born very preterm at term-equivalent age, likely reflecting disrupted brain maturational processes.

Asunto(s)

Encéfalo/crecimiento & desarrollo , Enfermedades del Prematuro/diagnóstico por imagen , Red Nerviosa/crecimiento & desarrollo , Encéfalo/diagnóstico por imagen , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Recien Nacido Extremadamente Prematuro , Recién Nacido , Enfermedades del Prematuro/patología , Imagen por Resonancia Magnética , Masculino , Red Nerviosa/diagnóstico por imagen , Estudios Prospectivos

RESUMEN

BACKGROUND: Necrotizing enterocolitis is the leading case of gastrointestinal-related morbidity in premature infants. Necrotizing enterocolitis totalis is an aggressive form of necrotizing enterocolitis, which has traditionally been managed with comfort care. Recent advances in management of short bowel syndrome have resulted in some reported long-term survival. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies that reported outcomes in children with necrotizing enterocolitis totalis were identified. The definition of necrotizing enterocolitis totalis was captured along with length of follow-up, patient demographics, and outcomes. RESULTS: A total of 766 articles were screened, of which 166 were selected for full article review. Of these, 32 articles included data on 414 patients with necrotizing enterocolitis totalis. In the majority of studies (52%), necrotizing enterocolitis totalis was not defined. Aggressive surgical therapy (defined as bowel resection or fecal diversion) was undertaken in 32 patients (7.7%), with a mortality rate of 68.8%. In contrast, nonaggressive surgical therapy was undertaken in 382 patients (92.3%), and the mortality in these patients was 95%. Long-term outcomes for necrotizing enterocolitis totalis survivors, such as length of time on parenteral nutrition, progression to liver and/or small bowel transplant, and quality of life, were not reported. CONCLUSION: We found that there is no accepted definition of necrotizing enterocolitis totalis. Aggressive surgical therapy is rarely pursued, which likely drives the overall high mortality rate. This study underscores the importance of standardizing the definition of necrotizing enterocolitis totalis and capturing short and long-term outcomes prospectively. With more aggressive surgical therapy, more infants are likely to survive this abdominal catastrophe, which was once thought to be uniformly fatal.

Asunto(s)

Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Enterocolitis Necrotizante/cirugía , Enfermedades del Prematuro/cirugía , Tratamiento Conservador/mortalidad , Procedimientos Quirúrgicos del Sistema Digestivo/mortalidad , Enterocolitis Necrotizante/diagnóstico , Enterocolitis Necrotizante/mortalidad , Enterocolitis Necrotizante/patología , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/mortalidad , Enfermedades del Prematuro/patología , Resultado del Tratamiento

Asunto(s)

Enfermedad de Chagas/diagnóstico , Enfermedades del Prematuro/diagnóstico , Enfermedades Placentarias/diagnóstico , Placenta/parasitología , Enfermedad Relacionada con los Viajes , Argentina , Enfermedad de Chagas/congénito , Enfermedad de Chagas/patología , Resultado Fatal , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/parasitología , Enfermedades del Prematuro/patología , New Jersey , Placenta/patología , Enfermedades Placentarias/parasitología , Enfermedades Placentarias/patología , Embarazo , Gemelos Dicigóticos

RESUMEN

Background: Achondrogenesis is a skeletal dysplasia characterized primarily by short stature, severe micromelia, short and narrow chest, prematurity, polyhydramnios, fetal hydrops, and in utero or neonatal death. Based on the radiological and histopathological findings, there are three types of achondrogenesis: type 1A (Houston-Harris), type 1B (Fraccaro) and type 2 (Langer-Saldino). Clinical case: A premature female product was studied whose clinical, radiological and histopathological characteristics were compatible with achondrogenesis Type 1A. The family information allowed us to conclude that the 4 products of the 6 previous pregnancies were affected. Statistical analysis in at least 4 families previously described, including this family case showed significant differences between expected and observed number of members, being incongruent with an autosomal recessive mode of inheritance previously reported. Conclusions: therefore, it could be considered a new subtype of achondrogenesis type 1A due to the presence of a preferential germline mutation.

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Introducción: La acondrogénesis es una displasia esquelética que se caracteriza principalmente por talla baja, micromelia grave, tórax corto y estrecho, prematurez, polihidramnios, hidropesía fetal y muerte fetal in utero o neonatal. Según los hallazgos radiológicos e histopatológicos existen tres tipos de acondrogénesis: tipo 1A (Houston-Harris), tipo 1B (Fraccaro) y tipo 2 (Langer-Saldino). Caso clínico: Se sometió a estudio a un producto femenino prematuro cuyas características clínicas, radiológicas e histopatológicas fueron compatibles con acondrogénesis tipo 1A. La información familiar permitió concluir que los cuatro productos de los seis embarazos previos se encontraban afectados. El análisis estadístico en por lo menos cuatro familias previamente descritas, incluyendo este caso familiar, mostró diferencias significativas entre el número de miembros esperado y el observado, siendo incongruente con el modo de herencia autosómico recesivo previamente reportado. Conclusiones: Podría considerarse un nuevo subtipo de acondrogénesis tipo 1A debida a la presencia de una mutación germinal preferencial.

Asunto(s)

Acondroplasia/clasificación , Enfermedades del Prematuro/clasificación , Anomalías Múltiples/genética , Acondroplasia/diagnóstico por imagen , Acondroplasia/genética , Acondroplasia/patología , Cartílago/patología , Resultado Fatal , Femenino , Fémur/patología , Mutación de Línea Germinal , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico por imagen , Enfermedades del Prematuro/genética , Enfermedades del Prematuro/patología , Linaje , Fenotipo , Polihidramnios/etiología , Embarazo

Asunto(s)

Displasia Broncopulmonar/patología , Displasia Broncopulmonar/fisiopatología , Hiperoxia/complicaciones , Recien Nacido Prematuro , Respiración Artificial/efectos adversos , Factores de Edad , Displasia Broncopulmonar/etiología , Preescolar , Comprensión , Progresión de la Enfermedad , Femenino , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/patología , Enfermedades del Prematuro/fisiopatología , Enfermedades del Prematuro/terapia , Masculino , Evaluación de Necesidades , Pronóstico , Respiración Artificial/métodos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales

RESUMEN

OBJECTIVE: To identify clinical risk factors for punctate white matter lesions (PWML) on early magnetic resonance imaging (MRI) in 2 cohorts of newborns born extremely preterm in different neonatal centers. STUDY DESIGN: A total of 250 newborns born preterm at less than 28 weeks of gestation (mean 26.4 ± 1.1 weeks) with an early MRI were identified from 2 neonatal centers, in Vancouver, Canada (cohort A, n = 100) and Utrecht, the Netherlands (cohort B, n = 150). Cohort A was imaged as part of a prospective research study and cohort B was imaged as part of routine clinical care. PWML were defined as cluster type foci of hyperintensity on T1-weighted imaging and were identified at a mean postmenstrual age of 31.1 (±1.9) weeks. Multivariable analysis was used to identify clinical factors predictive of PWML. RESULTS: Cluster type PWML were found in 47 newborns born extremely preterm (18.8%) and were more common in cohort A (32%) than in cohort B (10%). Newborns in cohort A generally were sicker than those in cohort B. Multivariable analyses revealed that greater birth weight (B = 0.002; P < .02), grade II-III intraventricular hemorrhage (B = 0.83; P < .02), and cohort A (B = 1.34; P < .0001) were independent predictors of PWML. CONCLUSION: Several risk factors for PWML on early MRI were identified. The interaction among birth weight, intraventricular hemorrhage, and other aspects of postnatal illness as risk factors for PWML warrants further investigation in newborns born extremely preterm and may help to identify modifiable risk factors for PWML.

Asunto(s)

Enfermedades del Prematuro/patología , Imagen por Resonancia Magnética/métodos , Sustancia Blanca/patología , Canadá , Femenino , Humanos , Recien Nacido Extremadamente Prematuro , Recién Nacido , Recien Nacido Prematuro , Masculino , Países Bajos , Estudios Prospectivos , Factores de Riesgo

RESUMEN

OBJECTIVE: To explore the association between brain maturation, injury, and volumes at term-equivalent age with 2-year development in moderate and late preterm children. STUDY DESIGN: Moderate and late preterm infants were recruited at birth and assessed at age 2 years using the Bayley Scales of Infant and Toddler Development, Third Edition. Brain magnetic resonance imaging (MRI) was performed at term-equivalent age and qualitatively assessed for brain maturation (myelination of the posterior limb of the internal capsule and gyral folding) and injury. Brain volumes were measured using advanced segmentation techniques. The associations between brain MRI measures with developmental outcomes were explored using linear regression analyses. RESULTS: A total of 197 children underwent MRI and assessed using the Bayley Scales of Infant and Toddler Development, Third Edition. Larger total brain tissue volumes were associated with higher cognitive and language scores (adjusted coefficients per 10% increase in brain size; 95% CI of 3.2 [0.4, 5.6] and 5.6 [2.4, 8.8], respectively). Similar relationships were documented for white matter volumes with cognitive and language scores, multiple cerebral structures with language scores, and cerebellar volumes with motor scores. Larger cerebellar volumes were independently associated with better language and motor scores, after adjustment for other perinatal factors. There was little evidence of relationships between myelination of the posterior limb of the internal capsule, gyral folding, or injury with 2-year development. CONCLUSIONS: Larger total brain tissue, white matter, and cerebellar volumes at term-equivalent age are associated with better neurodevelopment in moderate and late preterm children. Brain volumes may be an important marker for neurodevelopmental deficits described in moderate and late preterm children.

Asunto(s)

Encéfalo/crecimiento & desarrollo , Encéfalo/patología , Desarrollo Infantil , Enfermedades del Prematuro/patología , Trastornos del Neurodesarrollo/patología , Encéfalo/diagnóstico por imagen , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Trastornos del Neurodesarrollo/diagnóstico por imagen , Tamaño de los Órganos

RESUMEN

OBJECTIVES: To document associations between confirmed and suspected neonatal infection and motor, cognitive, educational, and mental health outcomes of very preterm (VPT)-born children at 9 years of age; to examine the potential intervening role of cerebral white matter abnormalities (WMAs) and structural development on term magnetic resonance imaging. STUDY DESIGN: A regional cohort of 110 infants born VPT in Christchurch, New Zealand were studied from birth to age of 9 years. Confirmed infection was defined as positive blood, cerebrospinal fluid or urine culture, and/or necrotizing enterocolitis ≥ stage 2. Suspected infection was defined as ≥ 5 days of antibiotics with evidence of clinical correlates. At term gestational equivalence, infants underwent structural magnetic resonance imaging. At age 9 years, neuromotor function, IQ, educational achievement, and mental health were assessed. RESULTS: During hospitalization, 25% of VPT infants had confirmed and 23% had suspected infection. Longer-term neurodevelopmental impairments were largely confined to infants with confirmed infection (relative risk 1.4-3.1, vs uninfected). After accounting for other neonatal factors, these infants were at increased risk of severe motor impairment (OR 3.3, 95% CI 1.3-8), attention deficit hyperactivity disorder (ADHD) (OR 3.6, 95% CI 1.6-8), and IQ delay (OR 2.0, 95% CI 1-3.9). Cerebral WMAs contributed to associations between confirmed infection and motor and IQ impairments but not to ADHD (P = .005). CONCLUSIONS: Confirmed neonatal infection heightens VPT infants' risk for neurodevelopmental impairment. WMA appears to be an important intervening factor linking infection and severe motor and IQ impairments. Further analysis of the neurologic mechanism accounting for ADHD in infants with infection is needed.

Asunto(s)

Encéfalo/patología , Discapacidades del Desarrollo/patología , Enfermedades del Prematuro/patología , Infecciones/complicaciones , Niño , Preescolar , Femenino , Humanos , Lactante , Recien Nacido Extremadamente Prematuro , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Nueva Zelanda , Factores de Riesgo

Asunto(s)

Aorta Abdominal , Coartación Aórtica/patología , Hipertensión/etiología , Enfermedades del Prematuro/patología , Arteria Renal/patología , Resultado Fatal , Humanos , Recien Nacido Extremadamente Prematuro , Recién Nacido , Masculino , Síndrome

Asunto(s)

Retardo del Crecimiento Fetal/diagnóstico por imagen , Progeria/diagnóstico por imagen , Ultrasonografía Prenatal , Cesárea , Huesos Faciales/diagnóstico por imagen , Huesos Faciales/embriología , Retardo del Crecimiento Fetal/terapia , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/patología , Enfermedades del Prematuro/terapia , Masculino , Examen Físico , Progeria/embriología , Progeria/terapia

RESUMEN

OBJECTIVE: To investigate sex differences in neurologic and developmental outcomes in extremely preterm (EPT) children and explore associations with neonatal brain morphology. STUDY DESIGN: A population-based cohort of infants born at <27 weeks gestation underwent magnetic resonance imaging (MRI) at term equivalent age (n = 107). Voxel-based morphometry (n = 27) and tract-based spatial statistics (n = 29) were performed in infants with normal MRI findings. Neurologic and developmental assessment (using the Bayley Scales of Infant and Toddler Development-Third Edition [BSITD-III]) was performed at 30 months corrected age (n = 91). RESULTS: EPT boys had lower mean cognitive composite scores (P = .03) and lower mean language composite scores (P = .04) compared with EPT girls. Rates of cerebral palsy were similar in the 2 sexes. No perinatal factor explained the variance in outcomes. Visual inspection of T1- and T2-weighted MRI images found that delayed myelination was found more frequently in boys, whereas cerebellar abnormalities were more common in girls. In the subgroup of children with normal MRI findings (n = 27), boys had poorer cognitive function (P = .015) and language function (P = .008), despite larger volumes of cerebellar tissue (P = .029). In boys, cerebellar volume was positively correlated with BSITD-III cognitive and motor scores (P = .04 for both). In girls, white matter volume (P = .02) and cortical gray matter volume (P = .03) were positively correlated with BSITD-III language score. At the regional level, significant correlations with outcomes were found only in girls. CONCLUSION: Cognitive and language outcomes at age 30 months were poorer in boys. Sex-related differences were observed on neonatal structural MRI, including differences in the patterns of correlations between brain volumes and developmental scores at both global and regional levels.

Asunto(s)

Encéfalo/patología , Parálisis Cerebral/etiología , Trastornos del Conocimiento/etiología , Discapacidades del Desarrollo/etiología , Recien Nacido Extremadamente Prematuro , Enfermedades del Prematuro/etiología , Trastornos del Desarrollo del Lenguaje/etiología , Parálisis Cerebral/diagnóstico , Parálisis Cerebral/patología , Preescolar , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/patología , Discapacidades del Desarrollo/diagnóstico , Discapacidades del Desarrollo/patología , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Enfermedades del Prematuro/diagnóstico , Enfermedades del Prematuro/patología , Trastornos del Desarrollo del Lenguaje/diagnóstico , Trastornos del Desarrollo del Lenguaje/patología , Modelos Lineales , Imagen por Resonancia Magnética , Masculino , Análisis Multivariante , Pruebas Neuropsicológicas , Estudios Prospectivos , Factores de Riesgo , Factores Sexuales

RESUMEN

AIM: The purpose of this study was to identify placental and umbilical cord macroscopic changes and correlate them to maternal and fetal clinical events in hypertensive disorders of pregnancy (HDP). MATERIALS AND METHODS: The authors examined 150 placentas, 30 from each HDP group, totaling 120, and 30 from the control group. All placentas and umbilical cords were examined, recorded, and photographed. RESULTS: The mean placental weight in the control group (526.3 +/- 95.6 g) was greater than in the HDP (435.5 +/- 43.1 g). Calciphylaxis was the most common macroscopic change found in the control and HDP groups in 27 (90%) and 118 cases (98.3%), respectively. DISCUSSION: Pregnant women with HDP were relatively younger. In addition, due to low blood flow seen in HDP, the macroscopic changes found included lower placental weight, calciphylaxis in the maternal surface, and fibrin in the fetal surface. Because of all complications associated, most women with HDP had preterm infants who developed respiratory problems and had shorter umbilical cords.

Asunto(s)

Hipertensión Inducida en el Embarazo/patología , Placenta/patología , Cordón Umbilical/patología , Calcifilaxia/patología , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/patología , Edad Materna , Tamaño de los Órganos , Embarazo , Estudios Prospectivos , Trastornos Respiratorios/patología

RESUMEN

OBJECTIVE: To determine a rate of internal diameter (ID), the narrowest of ductus arteriosus (DA)/body surface area (BSA) in preterm newborns (PTNB) for need for closure of DA either medically or surgically. MATERIAL AND METHODS: Prospective (cohort), held in a Neonatology Service in February 2010 to January 2011. Inclusion criteria were PTNB from 28 to 36 weeks of gestation from 0 to 28 days after birth, which confirmed diagnosis of patent ductus arteriosus (PDA) by echocardiogram, taking the narrowest ID, who did not present heart complex congenital or other major malformations in other systems without pulmonary arterial hypertension, that had not received drug treatment with prostaglandin inhibitors to close the DA. The exclusion criteria for complications of mechanical ventilation (air leaks, atelectasis, etc.) before measurements. BSA was determined based on their weight and height. There were two comparison groups during its evolution, those who finally merited either closure medical or surgical closure or was indicated but the poor conditions of the patient by the same PDA mainly, the procedure was not carried out (Group A) and Group B, those that are not operated or not medically closed DA not being hemodynamically significant [corrected]. Statistical analysis was performed using descriptive statistics and inferential. Significance levels were set at p < 0.05. RESULTS: The study population consisted of 32 patients who were divided into two groups: group A of 13 patients and group B with 19 patients. The study population characteristics between the two groups showed significant difference only in the Apgar Score for the Group B. In multivariate analysis found statistically significant as need for closure of DA only a index ID DA/ BSA when it was > 14. CONCLUSIONS: It is important to take into account a number of known ways to assess whether the DA is hemodynamically significant and therefore should be closed medically or surgically and according to this study, a parameter to requiring its closure is an index ID DA/BSA with a value > 14.

Asunto(s)

Antropometría , Superficie Corporal , Conducto Arterioso Permeable/patología , Conducto Arterioso Permeable/cirugía , Conducto Arterial/patología , Enfermedades del Prematuro/patología , Enfermedades del Prematuro/cirugía , Ligadura , Comorbilidad , Conducto Arterial/diagnóstico por imagen , Conducto Arterioso Permeable/diagnóstico por imagen , Femenino , Edad Gestacional , Hemodinámica , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/diagnóstico por imagen , Ligadura/estadística & datos numéricos , Masculino , Complicaciones Posoperatorias/epidemiología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad , Resultado del Tratamiento , Ultrasonografía , Procedimientos Innecesarios

RESUMEN

OBJECTIVE: To investigate the relationship between surgery in very preterm infants and brain structure at term equivalent and 2-year neurodevelopmental outcome. STUDY DESIGN: A total of 227 infants born at <30 weeks gestation or at a birth weight of <1250 g were prospectively enrolled into a longitudinal observational cohort for magnetic resonance imaging and developmental follow-up. The infants were categorized retrospectively into either a nonsurgical group (n=178) or a surgical group (n=30). Nineteen infants were excluded because of incomplete or unsuitable data. The surgical and nonsurgical groups were compared in terms of clinical demographic data, white matter injury, and brain volume at term. Neurodevelopmental outcome was assessed at age 2 years. RESULTS: Compared with the nonsurgical group, the infants in the surgical group were smaller and more growth-restricted at birth, received more respiratory support and oxygen therapy, and had longer hospital stays. They also had smaller brain volumes, particularly smaller deep nuclear gray matter volumes. Infants who underwent bowel surgery had greater white matter injury. Mental Developmental Index scores were lower in the surgical group, whereas Psychomotor Developmental Index scores did not differ between the groups. The Mental Developmental Index difference became nonsignificant after adjustment for confounding variables. CONCLUSION: Preterm infants exposed to surgery and anesthesia had greater white matter injury and smaller total brain volumes, particularly smaller deep nuclear gray matter volumes. Surgical exposure in the preterm infant should alert the clinician to an increased risk for adverse cognitive outcome.

Asunto(s)

Encéfalo/patología , Desarrollo Infantil , Enfermedades del Prematuro/cirugía , Procedimientos Quirúrgicos Operativos/efectos adversos , Anestesia/efectos adversos , Preescolar , Cognición , Conducto Arterioso Permeable/cirugía , Femenino , Hernia Inguinal/cirugía , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/patología , Recién Nacido de muy Bajo Peso , Intestinos/cirugía , Imagen por Resonancia Magnética , Masculino , Desempeño Psicomotor

RESUMEN

CONTEXT AND OBJECTIVE: High-resolution computed tomography (HRCT) is considered to be the best method for detailed pulmonary evaluation. The aim here was to describe a scoring system based on abnormalities identified on HRCT among premature infants, and measure the predictive validity of the score in relation to respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study in Instituto Fernandes Figueira, Fundação Oswaldo Cruz. METHODS: Scoring system based on HRCT abnormalities among premature newborns. The affected lung area was quantified according to the number of compromised lobes, in addition to bilateral pulmonary involvement. Two radiologists applied the score to 86 HRCT scans. Intraobserver and interobserver agreement were analyzed. The score properties were calculated in relation to predictions of respiratory morbidity during the first year of life. RESULTS: Most of the patients (85 percent) presented abnormalities on HRCT, and among these, 56.2 percent presented respiratory morbidity during the first year of life. Scores ranged from zero to 12. There was good agreement between observers (intraclass correlation coefficient, ICC = 0.86, confidence interval, CI: 0.64-0.83). The predictive scores were as follows: positive predictive value 81.8 percent, negative predictive value 56.3 percent, sensitivity 39.1 percent, and specificity 90.0 percent. CONCLUSION: The scoring system is reproducible, easy to apply and allows HRCT comparisons among premature infants, by identifying patients with greater likelihood of respiratory morbidity during the first year of life. Its use will enable HRCT comparisons among premature infants with different risk factors for respiratory morbidity.

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CONTEXTO E OBJETIVO: Tomografia computadorizada de alta resolução (TCAR) é considerada o melhor método para avaliação pulmonar detalhada. O objetivo foi descrever um sistema de escore baseado em alterações identificadas nas TCAR de lactentes prematuros e medir a validade preditiva do escore em relação à morbidade respiratória no primeiro ano de vida. TIPO DE ESTUDO E LOCAL: Estudo de coorte prospectiva no Instituto Fernandes Figueira, Fundação Oswaldo Cruz. MÉTODOS: Sistema de escore baseado em alterações nas TCAR de lactentes prematuros. A área pulmonar alterada foi quantificada conforme o número de lobos alterados, acrescido do comprometimento pulmonar bilateral. Dois radiologistas aplicaram o escore em 86 TCAR. Foram analisadas as confiabilidades intraobservador e interobservador e calculadas as propriedades do escore em relação à predição da morbidade respiratória no primeiro ano de vida. RESULTADOS: A maioria (85 por cento) dos pacientes apresentou TCAR anormal, e dentre estes, 56,2 por cento apresentaram morbidade respiratória no primeiro ano de vida. Valores do escore variaram de zero a 12. Houve boa concordância entre os observadores (coeficiente de correlação intraclasse, CCI = 0,86, intervalo de confiança, IC: 0,64-0,83). Os valores preditivos do escore foram: valor preditivo positivo 81,8 por cento, valor preditivo negativo 56,3 por cento, sensibilidade 39,1 por cento e especificidade 90,0 por cento. CONCLUSÃO: O sistema de escore é reprodutível, de fácil aplicação e permite a comparação de TCAR de pacientes prematuros, identificando pacientes com maior probabilidade de morbidade respiratória no primeiro de vida. Seu uso permitirá a comparação de TC de lactentes prematuros com diferentes fatores de risco para morbidade respiratória.

Asunto(s)

Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro , Enfermedades Pulmonares , Tomografía Computarizada por Rayos X/métodos , Métodos Epidemiológicos , Recien Nacido Prematuro , Enfermedades del Prematuro/mortalidad , Enfermedades del Prematuro/patología , Enfermedades Pulmonares/mortalidad , Enfermedades Pulmonares/patología , Tomografía Computarizada por Rayos X/normas

Asunto(s)

Humanos , Femenino , Embarazo , Recién Nacido , Lactante , Enterocolitis Necrotizante/patología , Epidemiología , Edad Gestacional , Enfermedades del Prematuro/patología

RESUMEN

CONTEXT AND OBJECTIVE: High-resolution computed tomography (HRCT) is considered to be the best method for detailed pulmonary evaluation. The aim here was to describe a scoring system based on abnormalities identified on HRCT among premature infants, and measure the predictive validity of the score in relation to respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study in Instituto Fernandes Figueira, Fundação Oswaldo Cruz. METHODS: Scoring system based on HRCT abnormalities among premature newborns. The affected lung area was quantified according to the number of compromised lobes, in addition to bilateral pulmonary involvement. Two radiologists applied the score to 86 HRCT scans. Intraobserver and interobserver agreement were analyzed. The score properties were calculated in relation to predictions of respiratory morbidity during the first year of life. RESULTS: Most of the patients (85%) presented abnormalities on HRCT, and among these, 56.2% presented respiratory morbidity during the first year of life. Scores ranged from zero to 12. There was good agreement between observers (intraclass correlation coefficient, ICC = 0.86, confidence interval, CI: 0.64-0.83). The predictive scores were as follows: positive predictive value 81.8%, negative predictive value 56.3%, sensitivity 39.1%, and specificity 90.0%. CONCLUSION: The scoring system is reproducible, easy to apply and allows HRCT comparisons among premature infants, by identifying patients with greater likelihood of respiratory morbidity during the first year of life. Its use will enable HRCT comparisons among premature infants with different risk factors for respiratory morbidity.

Asunto(s)

Enfermedades del Prematuro/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Métodos Epidemiológicos , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/mortalidad , Enfermedades del Prematuro/patología , Enfermedades Pulmonares/mortalidad , Enfermedades Pulmonares/patología , Tomografía Computarizada por Rayos X/normas

RESUMEN

OBJECTIVE: To determine whether preterm very low birth weight (VLBW) or term born small for gestational age (SGA) adolescents have reduced regional brain volumes. We also asked which perinatal factors are related to reduced brain volume in VLBW adolescents, which regional brain volumes are associated with cognitive and perceptual functioning, and if these differ between the groups. STUDY DESIGN: Fifty adolescent preterm VLBW (< or =1500 g) births and 49 term SGA births (birth weight <10th percentile) were compared with 57 normal-weight term births. An automated MRI segmentation technique was used. Cognitive and perceptual functions were evaluated by WISC-III and Visual Motor Integration (VMI) tests. RESULTS: The VLBW group had reduced volumes for thalamus and cerebellar white matter (P < .002). The SGA group had smaller total brains, and proportionally smaller regional brain volumes. Cerebellar white matter in the VLBW, hippocampus in the SGA, and cerebral cortical in the control group were volumes that significantly predicted cognitive and perceptual functions. CONCLUSIONS: We speculate that white matter injury may explain the impaired cognitive and perceptual functioning in the prematurely born, whereas hippocampal injury may be related to cognitive dysfunction in term SGA adolescents.

Asunto(s)

Encéfalo/patología , Cognición/fisiología , Enfermedades del Prematuro/patología , Enfermedades del Prematuro/psicología , Inteligencia/fisiología , Desempeño Psicomotor/fisiología , Adolescente , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Recién Nacido Pequeño para la Edad Gestacional , Recién Nacido de muy Bajo Peso , Imagen por Resonancia Magnética , Masculino , Tamaño de los Órganos , Factores de Riesgo