RESUMO
OBJECTIVE: To examine the association between neonatal cranial ultrasound (CUS) abnormalities among infants born extremely preterm and neurodevelopmental outcomes at 10 years of age. STUDY DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.
Assuntos
Hemorragia Cerebral Intraventricular/complicações , Hemorragia Cerebral Intraventricular/diagnóstico por imagem , Doenças do Prematuro/diagnóstico por imagem , Leucoencefalopatias/complicações , Leucoencefalopatias/diagnóstico por imagem , Transtornos do Neurodesenvolvimento/epidemiologia , Fatores Etários , Hemorragia Cerebral Intraventricular/terapia , Criança , Estudos de Coortes , Cuidados Críticos , Ecoencefalografia , Feminino , Hospitalização , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/terapia , Leucoencefalopatias/terapia , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Estados UnidosAssuntos
Cateteres de Demora/efeitos adversos , Drenagem/instrumentação , Desenho de Equipamento/instrumentação , Hidrocefalia/etiologia , Pressão Intracraniana , Distribuição de Qui-Quadrado , Ventrículos Cerebrais/anormalidades , Estudos Retrospectivos , Estudo Observacional , Confiabilidade dos Dados , Hemorragia Cerebral Intraventricular/terapiaRESUMO
PURPOSE: Intraventricular hemorrhage is the most important adverse neurologic event for preterm and very low weight birth infants in the neonatal period. This pathology can lead to various delays in motor, language, and cognition development. The aim of this article is to give an overview of the knowledge in diagnosis, classification, and treatment options of this pathology. METHOD: A systematic review has been made. RESULTS: The cranial ultrasound can be used to identify the hemorrhage and grade it according to the modified Papile grading system. There is no standardized protocol of intervention as there are controversial results on which of the temporizing neurosurgical procedures is best and about the appropriate parameters to consider a conversion to ventriculoperitoneal shunt. However, it has been established that the most important prognosis factor is the involvement and damage of the white matter. CONCLUSION: More evidence is required to create a standardized protocol that can ensure the best possible outcome for these patients.