Journal
JAMA PEDIATRICS
Volume 172, Issue 1, Pages 32-42Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/jamapediatrics.2017.3545
Keywords
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Categories
Funding
- National Institutes of Health
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- National Center for Research Resources via General Clinical Research Center)
- National Center for Research Resources via GCRC grants
- National Center for Advancing Translational Sciences (NCATS)
- Alpert Medical School of Brown University
- Women and Infants Hospital of Rhode Island (NICHD grant) [U10 HD27904]
- Case Western Reserve University
- Rainbow Babies and Children's Hospital [U10 HD21364]
- Rainbow Babies and Children's Hospital (GCRC grant) [M01 RR80]
- Duke University School of Medicine
- Duke Regional Hospital [U10 HD40492, M01 RR30]
- Duke Regional Hospital (NCATS grant) [UL1TR83]
- Children's Mercy Hospital [U10 HD68284]
- Cincinnati Children's Hospital Medical Center
- Good Samaritan Hospital [U10 HD27853]
- Good Samaritan Hospital (GCRC grant) [M01 RR8084]
- Emory University
- Children's Healthcare of Atlanta
- Grady Memorial Hospital
- Emory University Hospital Midtown [U10 HD27851, M01 RR39, UL1 TR454]
- Indiana University
- Methodist Hospital
- Riley Hospital for Children
- Wishard Health Services [U10 HD27856, M01 RR750, UL1TR6]
- Nationwide Children's Hospital
- Ohio State University Medical Center [U10 HD68278]
- RTI International [U10 HD36790]
- Stanford University
- Dominican Hospital
- El Camino Hospital
- Lucile Packard Children's Hospital [U10 HD27880, M01 RR70, UL1TR93]
- Tufts Medical Center
- Floating Hospital for Children [U10HD53119, M01 RR54]
- University of Alabama at Birmingham Health System
- Children's Hospital of Alabama [U10 HD34216, M01 RR32]
- University of California, Los Angeles
- Mattel Children's Hospital
- Santa Monica Hospital
- Los Robles Hospital and Medical Center
- Olive View Medical Center [U10 HD68270]
- University of California, San Diego Medical Center
- Sharp Mary Birch Hospital for Women and Newborns [U10HD40461]
- University of Iowa
- Mercy Medical Center [U10 HD53109, M01 RR59]
- University of Miami
- Holtz Children's Hospital [U10 HD21397, M01 RR16587]
- University of New Mexico Health Sciences Center [U10 HD53089, M01 RR997, UL1TR41]
- University of Pennsylvania
- Hospital of the University of Pennsylvania
- Pennsylvania Hospital
- Children's Hospital of Philadelphia [U10 HD68244]
- University of Rochester Medical Center
- Golisano Children's Hospital
- University of Buffalo Women's, and Children's Hospital of Buffalo [U10 HD68263, U10 HD40521, UL1 RR24160, M01 RR44, UL1 TR42]
- University of Texas Health Science Center at Houston Medical School
- Children's Memorial Hermann Hospital
- Lyndon Baines Johnson General Hospital/Harris County Hospital District [U10 HD21373]
- University of Texas Southwestern Medical Center at Dallas
- Parkland Health and Hospital System
- Children's Medical Center Dallas [U10 HD40689, M01 RR633]
- LDS Hospital
- Primary Children's Medical Center [U10 HD53124, M01 RR64, UL1 TR105]
- Wake Forest University
- Baptist Medical Center
- Forsyth Medical Center
- Brenner Children's Hospital [U10 HD40498, M01 RR7122]
- Wayne State University
- Hutzel Women's Hospital
- Children's Hospital of Michigan [U10 HD21385]
- Yale-New Haven Children's Hospital
- Bridgeport Hospital [U10 HD27871, UL1 RR24139, M01 RR125, UL1 TR142]
- EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT [UG1HD027904, UG1HD021385, UG1HD021364, UG1HD087226, UG1HD027853, UG1HD027880, UG1HD040689] Funding Source: NIH RePORTER
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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 study was 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 outcome was 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 Of 4193 neonates with ultrasonography data, 300 had nonhemorrhagic ventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomes were available for 3008 of 3345 neonates with ventriculomegaly or normal scans (90%). Compared with normal cranial ultrasonograms, ventriculomegaly was 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/neurodevelopmental impairment (OR, 2.17; 95% CI, 1.62-2.91), but not death alone (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.
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