Abstract
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 studywas 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 outcomewas 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 Of4193neonateswithultrasonographydata,300hadnonhemorrhagicventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomeswere available for3008of3345neonateswithventriculomegaly ornormalscans(90%).Comparedwith normal cranial ultrasonograms, ventriculomegalywas 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/neurodevelopmentalimpairment(OR,2.17;95%CI,1.62-2.91),butnotdeathalone (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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 32-42 |
| Number of pages | 11 |
| Journal | JAMA Pediatrics |
| Volume | 172 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2018 |
| Externally published | Yes |
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
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Neurodevelopmental and behavioral outcomes in extremely premature neonates with ventriculomegaly in the absence of periventricular-intraventricular hemorrhage. / Pappas, Athina; Adams-Chapman, Ira; Shankaran, Seetha; McDonald, Scott A.; Stoll, Barbara J.; Laptook, Abbot R.; Carlo, Waldemar A.; Van Meurs, Krisa P.; Hintz, Susan R.; Carlson, Martha D.; Brumbaugh, Jane E.; Walsh, Michele C.; Wyckoff, Myra H.; Das, Abhik; Higgins, Rosemary D.; Caplan, Michael S.; Polin, Richard A.; Keszler, Martin; Oh, William; Vohr, Betty R.; Hensman, Angelita M.; Basso, Kristin M.; Alksninis, Barbara; Burke, Robert; Caskey, Melinda; Halbrook, Andrea; Johnson, Katharine; Keszler, Mary Lenore; Leach, Theresa M.; Stephens, Bonnie E.; Ventura, Suzy; Watson, Victoria E.; Fanaroff, Avroy A.; Hibbs, Anna Marie; Wilson-Costello, Deanne E.; Newman, Nancy S.; Payne, Allison F.; Siner, Bonnie S.; Bhola, Monika; Yalcinkaya, Gulgun; Friedman, Harriet G.; Truog, William E.; Pallotto, Eugenia K.; Kilbride, Howard W.; Gauldin, Cheri; Holmes, Anne; Johnson, Kathy; Schibler, Kurt; Donovan, Edward F.; Grisby, Cathy; Alexander, Barbara; Bridges, Kate; Fischer, Estelle E.; Gratton, Teresa L.; Mincey, Holly L.; Muthig, Greg; Hessling, Jody; Jackson, Lenora D.; Kirker, Kristin; Yolton, Kimberly; Goldberg, Ronald N.; Cotten, C. Michael; Goldstein, Ricki F.; Gustafson, Kathryn E.; Finkle, Joanne; Ashley, Patricia L.; Malcolm, William F.; Auten, Kathy J.; Fisher, Kimberley A.; Foy, Katherine A.; Grimes, Sandra; Lohmeyer, Melody B.; Laughon, Matthew M.; Bose, Carl L.; Bernhardt, Janice; Bose, Gennie; Wereszczak, Janice K.; Carlton, David P.; Hale, Ellen C.; Loggins, Yvonne C.; LaRossa, Maureen Mulligan; Carter, Sheena L.; Archer, Stephanie Wilson; Sokol, Gregory M.; Poindexter, Brenda B.; Dusick, Anna M.; Papile, Lu Ann; Herron, Dianne E.; Miller, Lucy C.; Lytle, Carolyn; Cook, Ann B.; Minnich, Heike M.; Hines, Abbey C.; Wilson, Leslie Dawn; Hamer, Faithe; Sánchez, Pablo J.; Nelin, Leif D.; Jadcherla, Sudarshan R.; Yeates, Keith Owen; Luzader, Patricia; Fortney, Christine A.; Besner, Gail E.; Parikh, Nehal A.; Wallace, Dennis; Poole, W. Kenneth; Auman, Jeanette O.Donnell; Crawford, Margaret M.; Gantz, Marie G.; Newman, Jamie E.; Petrie Huitema, Carolyn M.; Zaterka-Baxter, Kristin M.; Stevenson, David K.; Ball, M. Bethany; Adams, Marian M.; Bentley, Barbara; Bruno, Elizabeth; DeAnda, Maria Elena; DeBattista, Anne M.; Huffman, Lynne C.; Kohn, Jean G.; Krueger, Casey E.; Palmquist, Andrew W.; Proud, Melinda S.; Tang, Brian; Weiss, Hali E.; Frantz, Ivan D.; Fiascone, John M.; McGowan, Elisabeth C.; MacKinnon, Brenda L.; Brussa, Ana K.; Furey, Anne; Nylen, Ellen; Sibley, Cecelia E.; Ambalavanan, Namasivayam; Peralta-Carcelen, Myriam; Collins, Monica V.; Cosby, Shirley S.; Phillips, Vivien A.; Biasini, Fred J.; Domnanovich, Kristy; Johnston, Kristen C.; Kiser, Carin; Kryzwanski, Sara; Nelson, Kathleen G.; Patterson, Cryshelle S.; Rector, Richard V.; Rodrigues, Leslie; Ryan, Sarah; Smith, Leigh Ann; Soong, Amanda D.; Whitley, Sally; Devaskar, Uday; Garg, Meena; Purdy, Isabell B.; Chanlaw, Teresa; Geller, Rachel; Finer, Neil N.; Kaegi, David; Rasmussen, Maynard R.; Vaucher, Yvonne E.; Arnell, Kathy; Demetrio, Clarence; Fuller, Martha G.; Henderson, Chris; Rich, Wade; West, Radmila; Bell, Edward F.; Ellsbury, Dan L.; Widness, John A.; Colaizy, Tarah T.; Acarregui, Michael J.; Johnson, Karen J.; Campbell, Donia B.; Eastman, Diane L.; Walker, Jacky R.; Duara, Shahnaz; Bauer, Charles R.; Everett-Thomas, Ruth; Fajardo-Hiriart, Sylvia; Rigaud, Arielle; Calejo, Maria; Frade Eguaras, Silvia M.; Berkowits, Michelle Harwood; Garcia, Andrea; Pierre, Helina; Stoerger, Alexandra; Watterberg, Kristi L.; Ohls, Robin K.; Duncan, Andrea H.; Fuller, Janell F.; Lacy, Conra Backstrom; Brown, Sandra; Hartenberger, Carol; Lowe, Jean R.; Montman, Rebecca A.; Schmidt, Barbara; Kirpalani, Haresh; DeMauro, Sara B.; Chaudhary, Aasma S.; Abbasi, Soraya; Mancini, Toni; Cucinotta, Dara M.; Bernbaum, Judy C.; Gerdes, Marsha; Hurt, Hallam; D'Angio, Carl T.; Phelps, Dale L.; Guillet, Ronnie; Myers, Gary J.; Reubens, Linda J.; Burnell, Erica; Hust, Diane; Johnson, Julie Babish; Hunn, Julianne; Jensen, Rosemary L.; Kushner, Emily; Maffett, Deanna; Merzbach, Joan; Wadkins, Holly I.M.; Yost, Kelley; Zwetsch, Lauren; Lakshminrusimha, Satyanarayana; Reynolds, Anne Marie; Osman, Farooq; Williams, Ashley; Wynn, Karen; Kennedy, Kathleen A.; Tyson, Jon E.; McDavid, Georgia E.; Alaniz, Nora I.; Burson, Katrina; Evans, Patricia W.; Green, Charles; Harris, Beverly Foley; Jiminez, Margarita; Lis, Anna E.; Martin, Sarah; Morris, Brenda H.; Poundstone, M. Layne; Robichaux, Peggy; Siddiki, Saba; Simmons, Maegan C.; Pierce Tate, Patti L.; Wright, Sharon L.; Brion, Luc P.; Heyne, Roy J.; Salhab, Walid A.; Rosenfeld, Charles R.; Vasil, Diana M.; Adams, Sally S.; Chen, Lijun; Guzman, Alicia; Hensley, Gaynelle; Heyne, Elizabeth T.; Leps, Melissa H.; Madden, Linda A.; Miller, Nancy A.; Morgan, Janet S.; Torres, Lizette E.; Boatman, Catherine Twell; Faix, Roger G.; Yoder, Bradley A.; Bodnar, Anna; Osborne, Karen A.; Baker, Shawna; Bird, Karie; Burnett, Jill; Cole, Laura; Jensen, Jennifer J.; Spencer, Cynthia; Steffen, Michael; Weaver-Lewis, Kimberlee; Winter, Sarah; Zanetti, Karen; O'Shea, T. Michael; Dillard, Robert G.; Washburn, Lisa K.; Jackson, Barbara G.; Peters, Nancy; Chiu, Korinne; Allred, Deborah Evans; Goldstein, Donald J.; Halfond, Raquel; Peterson, Carroll; Waldrep, Ellen L.; Welch, Cherrie D.; Morris, Melissa Whalen; Hounshell, Gail Wiley; Barks, John; Bara, Rebecca; Argento, Angela; Goldston, Laura A.; Johnson, Mary; Christensen, Mary; Wiggins, Stephanie; Ehrenkranz, Richard A.; Jacobs, Harris; Butler, Christine G.; Cervone, Patricia; Greisman, Sheila; Konstantino, Monica; Poulsen, Joann; Taft, Janet; Williams, Joanne; Romano, Elaine.
In: JAMA Pediatrics, Vol. 172, No. 1, 01.01.2018, p. 32-42.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Neurodevelopmental and behavioral outcomes in extremely premature neonates with ventriculomegaly in the absence of periventricular-intraventricular hemorrhage
AU - Pappas, Athina
AU - Adams-Chapman, Ira
AU - Shankaran, Seetha
AU - McDonald, Scott A.
AU - Stoll, Barbara J.
AU - Laptook, Abbot R.
AU - Carlo, Waldemar A.
AU - Van Meurs, Krisa P.
AU - Hintz, Susan R.
AU - Carlson, Martha D.
AU - Brumbaugh, Jane E.
AU - Walsh, Michele C.
AU - Wyckoff, Myra H.
AU - Das, Abhik
AU - Higgins, Rosemary D.
AU - Caplan, Michael S.
AU - Polin, Richard A.
AU - Keszler, Martin
AU - Oh, William
AU - Vohr, Betty R.
AU - Hensman, Angelita M.
AU - Basso, Kristin M.
AU - Alksninis, Barbara
AU - Burke, Robert
AU - Caskey, Melinda
AU - Halbrook, Andrea
AU - Johnson, Katharine
AU - Keszler, Mary Lenore
AU - Leach, Theresa M.
AU - Stephens, Bonnie E.
AU - Ventura, Suzy
AU - Watson, Victoria E.
AU - Fanaroff, Avroy A.
AU - Hibbs, Anna Marie
AU - Wilson-Costello, Deanne E.
AU - Newman, Nancy S.
AU - Payne, Allison F.
AU - Siner, Bonnie S.
AU - Bhola, Monika
AU - Yalcinkaya, Gulgun
AU - Friedman, Harriet G.
AU - Truog, William E.
AU - Pallotto, Eugenia K.
AU - Kilbride, Howard W.
AU - Gauldin, Cheri
AU - Holmes, Anne
AU - Johnson, Kathy
AU - Schibler, Kurt
AU - Donovan, Edward F.
AU - Grisby, Cathy
AU - Alexander, Barbara
AU - Bridges, Kate
AU - Fischer, Estelle E.
AU - Gratton, Teresa L.
AU - Mincey, Holly L.
AU - Muthig, Greg
AU - Hessling, Jody
AU - Jackson, Lenora D.
AU - Kirker, Kristin
AU - Yolton, Kimberly
AU - Goldberg, Ronald N.
AU - Cotten, C. Michael
AU - Goldstein, Ricki F.
AU - Gustafson, Kathryn E.
AU - Finkle, Joanne
AU - Ashley, Patricia L.
AU - Malcolm, William F.
AU - Auten, Kathy J.
AU - Fisher, Kimberley A.
AU - Foy, Katherine A.
AU - Grimes, Sandra
AU - Lohmeyer, Melody B.
AU - Laughon, Matthew M.
AU - Bose, Carl L.
AU - Bernhardt, Janice
AU - Bose, Gennie
AU - Wereszczak, Janice K.
AU - Carlton, David P.
AU - Hale, Ellen C.
AU - Loggins, Yvonne C.
AU - LaRossa, Maureen Mulligan
AU - Carter, Sheena L.
AU - Archer, Stephanie Wilson
AU - Sokol, Gregory M.
AU - Poindexter, Brenda B.
AU - Dusick, Anna M.
AU - Papile, Lu Ann
AU - Herron, Dianne E.
AU - Miller, Lucy C.
AU - Lytle, Carolyn
AU - Cook, Ann B.
AU - Minnich, Heike M.
AU - Hines, Abbey C.
AU - Wilson, Leslie Dawn
AU - Hamer, Faithe
AU - Sánchez, Pablo J.
AU - Nelin, Leif D.
AU - Jadcherla, Sudarshan R.
AU - Yeates, Keith Owen
AU - Luzader, Patricia
AU - Fortney, Christine A.
AU - Besner, Gail E.
AU - Parikh, Nehal A.
AU - Wallace, Dennis
AU - Poole, W. Kenneth
AU - Auman, Jeanette O.Donnell
AU - Crawford, Margaret M.
AU - Gantz, Marie G.
AU - Newman, Jamie E.
AU - Petrie Huitema, Carolyn M.
AU - Zaterka-Baxter, Kristin M.
AU - Stevenson, David K.
AU - Ball, M. Bethany
AU - Adams, Marian M.
AU - Bentley, Barbara
AU - Bruno, Elizabeth
AU - DeAnda, Maria Elena
AU - DeBattista, Anne M.
AU - Huffman, Lynne C.
AU - Kohn, Jean G.
AU - Krueger, Casey E.
AU - Palmquist, Andrew W.
AU - Proud, Melinda S.
AU - Tang, Brian
AU - Weiss, Hali E.
AU - Frantz, Ivan D.
AU - Fiascone, John M.
AU - McGowan, Elisabeth C.
AU - MacKinnon, Brenda L.
AU - Brussa, Ana K.
AU - Furey, Anne
AU - Nylen, Ellen
AU - Sibley, Cecelia E.
AU - Ambalavanan, Namasivayam
AU - Peralta-Carcelen, Myriam
AU - Collins, Monica V.
AU - Cosby, Shirley S.
AU - Phillips, Vivien A.
AU - Biasini, Fred J.
AU - Domnanovich, Kristy
AU - Johnston, Kristen C.
AU - Kiser, Carin
AU - Kryzwanski, Sara
AU - Nelson, Kathleen G.
AU - Patterson, Cryshelle S.
AU - Rector, Richard V.
AU - Rodrigues, Leslie
AU - Ryan, Sarah
AU - Smith, Leigh Ann
AU - Soong, Amanda D.
AU - Whitley, Sally
AU - Devaskar, Uday
AU - Garg, Meena
AU - Purdy, Isabell B.
AU - Chanlaw, Teresa
AU - Geller, Rachel
AU - Finer, Neil N.
AU - Kaegi, David
AU - Rasmussen, Maynard R.
AU - Vaucher, Yvonne E.
AU - Arnell, Kathy
AU - Demetrio, Clarence
AU - Fuller, Martha G.
AU - Henderson, Chris
AU - Rich, Wade
AU - West, Radmila
AU - Bell, Edward F.
AU - Ellsbury, Dan L.
AU - Widness, John A.
AU - Colaizy, Tarah T.
AU - Acarregui, Michael J.
AU - Johnson, Karen J.
AU - Campbell, Donia B.
AU - Eastman, Diane L.
AU - Walker, Jacky R.
AU - Duara, Shahnaz
AU - Bauer, Charles R.
AU - Everett-Thomas, Ruth
AU - Fajardo-Hiriart, Sylvia
AU - Rigaud, Arielle
AU - Calejo, Maria
AU - Frade Eguaras, Silvia M.
AU - Berkowits, Michelle Harwood
AU - Garcia, Andrea
AU - Pierre, Helina
AU - Stoerger, Alexandra
AU - Watterberg, Kristi L.
AU - Ohls, Robin K.
AU - Duncan, Andrea H.
AU - Fuller, Janell F.
AU - Lacy, Conra Backstrom
AU - Brown, Sandra
AU - Hartenberger, Carol
AU - Lowe, Jean R.
AU - Montman, Rebecca A.
AU - Schmidt, Barbara
AU - Kirpalani, Haresh
AU - DeMauro, Sara B.
AU - Chaudhary, Aasma S.
AU - Abbasi, Soraya
AU - Mancini, Toni
AU - Cucinotta, Dara M.
AU - Bernbaum, Judy C.
AU - Gerdes, Marsha
AU - Hurt, Hallam
AU - D'Angio, Carl T.
AU - Phelps, Dale L.
AU - Guillet, Ronnie
AU - Myers, Gary J.
AU - Reubens, Linda J.
AU - Burnell, Erica
AU - Hust, Diane
AU - Johnson, Julie Babish
AU - Hunn, Julianne
AU - Jensen, Rosemary L.
AU - Kushner, Emily
AU - Maffett, Deanna
AU - Merzbach, Joan
AU - Wadkins, Holly I.M.
AU - Yost, Kelley
AU - Zwetsch, Lauren
AU - Lakshminrusimha, Satyanarayana
AU - Reynolds, Anne Marie
AU - Osman, Farooq
AU - Williams, Ashley
AU - Wynn, Karen
AU - Kennedy, Kathleen A.
AU - Tyson, Jon E.
AU - McDavid, Georgia E.
AU - Alaniz, Nora I.
AU - Burson, Katrina
AU - Evans, Patricia W.
AU - Green, Charles
AU - Harris, Beverly Foley
AU - Jiminez, Margarita
AU - Lis, Anna E.
AU - Martin, Sarah
AU - Morris, Brenda H.
AU - Poundstone, M. Layne
AU - Robichaux, Peggy
AU - Siddiki, Saba
AU - Simmons, Maegan C.
AU - Pierce Tate, Patti L.
AU - Wright, Sharon L.
AU - Brion, Luc P.
AU - Heyne, Roy J.
AU - Salhab, Walid A.
AU - Rosenfeld, Charles R.
AU - Vasil, Diana M.
AU - Adams, Sally S.
AU - Chen, Lijun
AU - Guzman, Alicia
AU - Hensley, Gaynelle
AU - Heyne, Elizabeth T.
AU - Leps, Melissa H.
AU - Madden, Linda A.
AU - Miller, Nancy A.
AU - Morgan, Janet S.
AU - Torres, Lizette E.
AU - Boatman, Catherine Twell
AU - Faix, Roger G.
AU - Yoder, Bradley A.
AU - Bodnar, Anna
AU - Osborne, Karen A.
AU - Baker, Shawna
AU - Bird, Karie
AU - Burnett, Jill
AU - Cole, Laura
AU - Jensen, Jennifer J.
AU - Spencer, Cynthia
AU - Steffen, Michael
AU - Weaver-Lewis, Kimberlee
AU - Winter, Sarah
AU - Zanetti, Karen
AU - O'Shea, T. Michael
AU - Dillard, Robert G.
AU - Washburn, Lisa K.
AU - Jackson, Barbara G.
AU - Peters, Nancy
AU - Chiu, Korinne
AU - Allred, Deborah Evans
AU - Goldstein, Donald J.
AU - Halfond, Raquel
AU - Peterson, Carroll
AU - Waldrep, Ellen L.
AU - Welch, Cherrie D.
AU - Morris, Melissa Whalen
AU - Hounshell, Gail Wiley
AU - Barks, John
AU - Bara, Rebecca
AU - Argento, Angela
AU - Goldston, Laura A.
AU - Johnson, Mary
AU - Christensen, Mary
AU - Wiggins, Stephanie
AU - Ehrenkranz, Richard A.
AU - Jacobs, Harris
AU - Butler, Christine G.
AU - Cervone, Patricia
AU - Greisman, Sheila
AU - Konstantino, Monica
AU - Poulsen, Joann
AU - Taft, Janet
AU - Williams, Joanne
AU - Romano, Elaine
PY - 2018/1/1
Y1 - 2018/1/1
N2 - 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 studywas 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 outcomewas 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 Of4193neonateswithultrasonographydata,300hadnonhemorrhagicventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomeswere available for3008of3345neonateswithventriculomegaly ornormalscans(90%).Comparedwith normal cranial ultrasonograms, ventriculomegalywas 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/neurodevelopmentalimpairment(OR,2.17;95%CI,1.62-2.91),butnotdeathalone (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.
AB - 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 studywas 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 outcomewas 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 Of4193neonateswithultrasonographydata,300hadnonhemorrhagicventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomeswere available for3008of3345neonateswithventriculomegaly ornormalscans(90%).Comparedwith normal cranial ultrasonograms, ventriculomegalywas 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/neurodevelopmentalimpairment(OR,2.17;95%CI,1.62-2.91),butnotdeathalone (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.
UR - http://www.scopus.com/inward/record.url?scp=85039926034&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85039926034&partnerID=8YFLogxK
U2 - 10.1001/jamapediatrics.2017.3545
DO - 10.1001/jamapediatrics.2017.3545
M3 - Article
C2 - 29181530
AN - SCOPUS:85039926034
VL - 172
SP - 32
EP - 42
JO - JAMA Pediatrics
JF - JAMA Pediatrics
SN - 2168-6203
IS - 1
ER -