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Multicenter Study
. 2021 Oct:237:197-205.e4.
doi: 10.1016/j.jpeds.2021.05.059. Epub 2021 Jun 4.

Neonatal Cranial Ultrasound Findings among Infants Born Extremely Preterm: Associations with Neurodevelopmental Outcomes at 10 Years of Age

Heather Campbell  1 , Jennifer Check  2 , Karl C K Kuban  3 , Alan Leviton  4 , Robert M Joseph  5 , Jean A Frazier  6 , Laurie M Douglass  3 , Kyle Roell  1 , Elizabeth N Allred  4 , Lynn Ansley Fordham  7 , Stephen R Hooper  8 , Hernan Jara  9 , Nigel Paneth  10 , Irina Mokrova  11 , Hongyu Ru  1 , Hudson P Santos Jr  12 , Rebecca C Fry  13 , T Michael O'Shea  14
Affiliations
Multicenter Study

Neonatal Cranial Ultrasound Findings among Infants Born Extremely Preterm: Associations with Neurodevelopmental Outcomes at 10 Years of Age

Heather Campbell et al. J Pediatr. 2021 Oct.

Abstract

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.

Keywords: extreme prematurity; intraventricular hemorrhage; neurodevelopmental outcomes; perinatal brain injury; ultrasound; white matter injury.

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Figures

Figure 1; online:
Figure 1; online:
Flowchart of study participant enrollment
Figure 2:
Figure 2:
Association between ultrasound findings and neurodevelopmental outcomes. Adjusted odds ratios are adjusted for gestational age, birthweight z-score, sex, maternal education, bronchopulmonary dysplasia, sepsis, necrotizing enterocolitis (Bell Stage 2 or 3), and severe retinopathy of prematurity. Abbreviations: CI- confidence interval; IVH- intraventricular hemorrhage; WMD- white matter damage defined as cerebral echolucency or late moderate-to-severe ventriculomegaly
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