Neurodevelopmental outcomes of extremely low-gestational-age neonates with low-grade periventricular-intraventricular hemorrhage
Allison H Payne, Susan R Hintz, Anna Maria Hibbs, Michele C Walsh, Betty R Vohr, Carla M Bann, Deanne E Wilson-Costello, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Michael S Caplan, Abbot R Laptook, Angelita M Hensman, Robert Burke, Melinda Caskey, Katharine Johnson, Barbara Alksninis, Dawn Andrews, Kristen Angela, Theresa M Leach, Victoria E Watson, Suzy Ventura, Avroy A Fanaroff, Nancy S Newman, Bonnie S Siner, Monika Bhola, Gulgun Yalcinkaya, Harriet G Friedman, Kurt Schibler, Edward F Donovan, Kate Bridges, Barbara Alexander, Cathy Grisby, Holly L Mincey, Jody Hessling, Teresa L Gratton, Jean J Steichen, Kimberly Yolton, Ronald N Goldberg, C Michael Cotten, Kathy J Auten, Kimberley A Fisher, Sandra Grimes, Kathryn E Gustafson, Melody B Lohmeyer, Barbara J Stoll, David P Carlton, Ellen C Hale, Rosemary D Higgins, Stephanie Wilson Archer, Brenda B Poindexter, Anna M Dusick, Leslie Dawn Wilson, Faithe Hamer, Carolyn Lytle, Heike M Minnich, Abhik Das, W Kenneth Poole, Dennis Wallace, Jamie E Newman, Jeanette O' Donnell Auman, Margaret Cunningham, Carolyn M Petrie Huitema, Kristin M Zaterka-Baxter, Krisa P Van Meurs, David K Stevenson, Alexis S Davis, M S Epi, M Bethany Ball, Andrew W Palmquist, Melinda S Proud, Elizabeth Bruno, Maria Elena DeAnda, Anne M DeBattista, Jean G Kohn, Hali E Weiss, Ivan D Frantz 3rd, John M Fiascone, Brenda L MacKinnon, Anne Furey, Ellen Nylen, Elisabeth C McGowan, Waldemar A Carlo, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Monica V Collins, Shirley S Cosby, Fred J Biasini, Kristen C Johnston, Kathleen G Nelson, Cryshelle S Patterson, Vivien A Phillips, Sally Whitley, Neil N Finer, Yvonne E Vaucher, David Kaegi, Maynard R Rasmussen, David Kaegi, Kathy Arnell, Clarence Demetrio, Martha G Fuller, Wade Rich, Radmila West, Edward F Bell, Michael J Acarregui, Karen J Johnson, Diane L Eastman, Shahnaz Duara, Charles R Bauer, Ruth Everett-Thomas, Sylvia Hiriart-Fajardo, Arielle Rigaud, Maria Calejo, Silvia M Frade Eguaras, Michelle Harwood Berkowits, Andrea Garcia, Helina Pierre, Alexandra Stoerger, Kristi L Watterberg, Jean R Lowe, Janell F Fuller, Robin K Ohls, Conra Backstrom Lacy, Rebecca Montman, Dale L Phelps, Gary J Myers, Linda J Reubens, Erica Burnell, Diane Hust, Julie Babish Johnson, Rosemary L Jensen, Emily Kushner, Joan Merzbach, Kelley Yost, Lauren Zwetsch, Kathleen A Kennedy, Jon E Tyson, Nora I Alaniz, Patricia W Evans, Charles Green, Beverly Foley Harris, Margarita Jiminez, Anna E Lis, Sarah Martin, E McDavid, Brenda H Morris, M Layne Poundstone, Saba Siddiki, Maegan C Simmons, Patti L Pierce Tate, Sharon L Wright, Pablo J Sánchez, Roy J Heyne, Walid A Salhab, Charles R Rosenfeld, Alicia Guzman, Melissa H Leps, Nancy A Miller, Gaynelle Hensley, Sally S Adams, Linda A Madden, Elizabeth Heyne, Janet S Morgan, Catherine Twell Boatman, Lizette E Torres, Roger G Faix, Bradley A Yoder, Karen A Osborne, Cynthia Spencer, Kimberlee Weaver-Lewis, Shawna Baker, Karie Bird, Jill Burnett, Mike Steffen, Karen Zanetti, T Michael O' Shea, Robert G Dillard, Lisa K Washburn, Barbara G Jackson, Nancy Peters, Korinne Chiu, Deborah Evans Allred, Donald J Goldstein, Raquel Halfond, Carroll Peterson, Ellen L Waldrep, Cherrie D Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Seetha Shankaran, Athina Pappas, Rebecca Bara, Laura A Goldston, Richard A Ehrenkranz, Harris Jacobs, Christine G Butler, Patricia Cervone, Sheila Greisman, Monica Konstantino, JoAnn Poulsen, Janet Taft, Joanne Williams, Elaine Romano, Allison H Payne, Susan R Hintz, Anna Maria Hibbs, Michele C Walsh, Betty R Vohr, Carla M Bann, Deanne E Wilson-Costello, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Michael S Caplan, Abbot R Laptook, Angelita M Hensman, Robert Burke, Melinda Caskey, Katharine Johnson, Barbara Alksninis, Dawn Andrews, Kristen Angela, Theresa M Leach, Victoria E Watson, Suzy Ventura, Avroy A Fanaroff, Nancy S Newman, Bonnie S Siner, Monika Bhola, Gulgun Yalcinkaya, Harriet G Friedman, Kurt Schibler, Edward F Donovan, Kate Bridges, Barbara Alexander, Cathy Grisby, Holly L Mincey, Jody Hessling, Teresa L Gratton, Jean J Steichen, Kimberly Yolton, Ronald N Goldberg, C Michael Cotten, Kathy J Auten, Kimberley A Fisher, Sandra Grimes, Kathryn E Gustafson, Melody B Lohmeyer, Barbara J Stoll, David P Carlton, Ellen C Hale, Rosemary D Higgins, Stephanie Wilson Archer, Brenda B Poindexter, Anna M Dusick, Leslie Dawn Wilson, Faithe Hamer, Carolyn Lytle, Heike M Minnich, Abhik Das, W Kenneth Poole, Dennis Wallace, Jamie E Newman, Jeanette O' Donnell Auman, Margaret Cunningham, Carolyn M Petrie Huitema, Kristin M Zaterka-Baxter, Krisa P Van Meurs, David K Stevenson, Alexis S Davis, M S Epi, M Bethany Ball, Andrew W Palmquist, Melinda S Proud, Elizabeth Bruno, Maria Elena DeAnda, Anne M DeBattista, Jean G Kohn, Hali E Weiss, Ivan D Frantz 3rd, John M Fiascone, Brenda L MacKinnon, Anne Furey, Ellen Nylen, Elisabeth C McGowan, Waldemar A Carlo, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Monica V Collins, Shirley S Cosby, Fred J Biasini, Kristen C Johnston, Kathleen G Nelson, Cryshelle S Patterson, Vivien A Phillips, Sally Whitley, Neil N Finer, Yvonne E Vaucher, David Kaegi, Maynard R Rasmussen, David Kaegi, Kathy Arnell, Clarence Demetrio, Martha G Fuller, Wade Rich, Radmila West, Edward F Bell, Michael J Acarregui, Karen J Johnson, Diane L Eastman, Shahnaz Duara, Charles R Bauer, Ruth Everett-Thomas, Sylvia Hiriart-Fajardo, Arielle Rigaud, Maria Calejo, Silvia M Frade Eguaras, Michelle Harwood Berkowits, Andrea Garcia, Helina Pierre, Alexandra Stoerger, Kristi L Watterberg, Jean R Lowe, Janell F Fuller, Robin K Ohls, Conra Backstrom Lacy, Rebecca Montman, Dale L Phelps, Gary J Myers, Linda J Reubens, Erica Burnell, Diane Hust, Julie Babish Johnson, Rosemary L Jensen, Emily Kushner, Joan Merzbach, Kelley Yost, Lauren Zwetsch, Kathleen A Kennedy, Jon E Tyson, Nora I Alaniz, Patricia W Evans, Charles Green, Beverly Foley Harris, Margarita Jiminez, Anna E Lis, Sarah Martin, E McDavid, Brenda H Morris, M Layne Poundstone, Saba Siddiki, Maegan C Simmons, Patti L Pierce Tate, Sharon L Wright, Pablo J Sánchez, Roy J Heyne, Walid A Salhab, Charles R Rosenfeld, Alicia Guzman, Melissa H Leps, Nancy A Miller, Gaynelle Hensley, Sally S Adams, Linda A Madden, Elizabeth Heyne, Janet S Morgan, Catherine Twell Boatman, Lizette E Torres, Roger G Faix, Bradley A Yoder, Karen A Osborne, Cynthia Spencer, Kimberlee Weaver-Lewis, Shawna Baker, Karie Bird, Jill Burnett, Mike Steffen, Karen Zanetti, T Michael O' Shea, Robert G Dillard, Lisa K Washburn, Barbara G Jackson, Nancy Peters, Korinne Chiu, Deborah Evans Allred, Donald J Goldstein, Raquel Halfond, Carroll Peterson, Ellen L Waldrep, Cherrie D Welch, Melissa Whalen Morris, Gail Wiley Hounshell, Seetha Shankaran, Athina Pappas, Rebecca Bara, Laura A Goldston, Richard A Ehrenkranz, Harris Jacobs, Christine G Butler, Patricia Cervone, Sheila Greisman, Monica Konstantino, JoAnn Poulsen, Janet Taft, Joanne Williams, Elaine Romano
Abstract
Importance: Low-grade periventricular-intraventricular hemorrhage is a common neurologic morbidity among extremely low-gestational-age neonates, yet the outcomes associated with this morbidity are not fully understood. In a contemporary multicenter cohort, we evaluated the impact of such hemorrhages on early (18-22 month) neurodevelopmental outcomes of extremely premature infants.
Objective: To compare neurodevelopmental outcomes at 18 to 22 months' corrected age for extremely low-gestational-age infants with low-grade (grade 1 or 2) periventricular-intraventricular hemorrhage with those of infants with either no hemorrhage or severe (grade 3 or 4) hemorrhage demonstrated on cranial ultrasonography.
Design: Longitudinal observational study.
Setting: Sixteen centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.
Participants: A total of 1472 infants born at less than 27 weeks' gestational age between January 1, 2006, and December 31, 2008, with ultrasonography results within the first 28 days of life and surviving to 18 to 22 months with complete follow-up assessments were eligible.
Main exposure: Low-grade periventricular-intraventricular hemorrhage.
Main outcome measures: Outcomes included cerebral palsy; gross motor functional limitation; cognitive and language scores according to the Bayley Scales of Infant Development, 3rd Edition; and composite measures of neurodevelopmental impairment. Regression modeling evaluated the association of hemorrhage severity with adverse outcomes while controlling for potentially confounding variables and center differences.
Results: Low-grade hemorrhage was not associated with significant differences in unadjusted or adjusted risk of any adverse neurodevelopmental outcome compared with infants without hemorrhage. Compared with low-grade hemorrhage, severe hemorrhage was associated with decreased adjusted continuous cognitive (β, -3.91 [95% CI, -6.41 to -1.42]) and language (β, -3.19 [-6.19 to -0.19]) scores as well as increased odds of each adjusted categorical outcome except severe cognitive impairment (odds ratio [OR], 1.46 [0.74 to 2.88]) and mild language impairment (OR, 1.35 [0.88 to 2.06]).
Conclusions and relevance: At 18 to 22 months, the neurodevelopmental outcomes of extremely low-gestational-age infants with low-grade periventricular-intraventricular hemorrhage are not significantly different from those without hemorrhage. Additional study at school age and beyond would be informative.
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Source: PubMed