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Meta-Analysis
. 2022 Dec 1;150(6):e2022057442.
doi: 10.1542/peds.2022-057442.

Preterm Brain Injury and Neurodevelopmental Outcomes: A Meta-analysis

Philippa Rees  1 , Caitriona Callan  2 , Karan R Chadda  3 , Meriel Vaal  1 , James Diviney  4 , Shahad Sabti  5 , Fergus Harnden  6 , Julian Gardiner  1 , Cheryl Battersby, Chris Gale, Alastair Sutcliffe  1
Affiliations
Meta-Analysis

Preterm Brain Injury and Neurodevelopmental Outcomes: A Meta-analysis

Philippa Rees et al. Pediatrics. .

Abstract

Context: Preterm brain injuries are common; neurodevelopmental outcomes following contemporary neonatal care are continually evolving.

Objective: To systematically review and meta-analyze neurodevelopmental outcomes among preterm infants after intraventricular hemorrhage (IVH) and white matter injury (WMI).

Data sources: Published and grey literature were searched across 10 databases between 2000 and 2021.

Study selection: Observational studies reporting 3-year neurodevelopmental outcomes for preterm infants with IVH or WMI compared with preterm infants without injury.

Data extraction: Study characteristics, population characteristics, and outcome data were extracted.

Results: Thirty eight studies were included. There was an increased adjusted risk of moderate-severe neurodevelopmental impairment after IVH grade 1 to 2 (adjusted odds ratio 1.35 [95% confidence interval 1.05-1.75]) and IVH grade 3 to 4 (adjusted odds ratio 4.26 [3.25-5.59]). Children with IVH grade 1 to 2 had higher risks of cerebral palsy (odds ratio [OR] 1.76 [1.39-2.24]), cognitive (OR 1.79 [1.09-2.95]), hearing (OR 1.83 [1.03-3.24]), and visual impairment (OR 1.77 [1.08-2.9]). Children with IVH grade 3 to 4 had markedly higher risks of cerebral palsy (OR 4.98 [4.13-6.00]), motor (OR 2.7 [1.52-4.8]), cognitive (OR 2.3 [1.67-3.15]), hearing (OR 2.44 [1.42-4.2]), and visual impairment (OR 5.42 [2.77-10.58]). Children with WMI had much higher risks of cerebral palsy (OR 14.91 [7.3-30.46]), motor (OR 5.3 [3-9.36]), and cognitive impairment (OR 3.48 [2.18-5.53]).

Limitations: Heterogeneity of outcome data.

Conclusions: Mild IVH, severe IVH, and WMI are associated with adverse neurodevelopmental outcomes. Utilization of core outcome sets and availability of open-access study data would improve our understanding of the nuances of these outcomes.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: Professor Gale is funded by the United Kingdom Medical Research Council through a Transition Support Award. In the past 5 years He has received support from Chiesi Pharmaceuticals to attend an educational conference and has been investigator on received research grants from Medical Research Council, National Institutes of Health Research, Canadian Institute of Health Research, Department of Health in England, Mason Medical Research Foundation, Westminster Medical School Research Trust, and Chiesi Pharmaceuticals. Professor Gale is funded by the United Kingdom National Institutes of Health Research Advanced Fellowship Award.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram of included and excluded studies.
FIGURE 2
FIGURE 2
Forest plot of the crude risk of neurodevelopmental impairment after IVH grade 1 to 2. NDI, neurodevelopmental impairment.
FIGURE 3
FIGURE 3
Forest plot of the adjusted risk of neurodevelopmental impairment after IVH grade 1 to 2. NDI, neurodevelopmental impairment.
FIGURE 4
FIGURE 4
Forest plot of the crude risk of cerebral palsy after IVH grade 1 to 2.
FIGURE 5
FIGURE 5
Forest plot of the crude risk of hearing impairment after IVH grade 1 to 2.
FIGURE 6
FIGURE 6
Forest plot of the crude risk of visual impairment after IVH grade 1 to 2.
FIGURE 7
FIGURE 7
Forest plot of the crude risk of neurodevelopmental impairment after IVH grade 3 to 4. NDI, neurodevelopmental impairment.
FIGURE 8
FIGURE 8
Forest plot of the adjusted risk of neurodevelopmental impairment after IVH grade 3 to 4. NDI, neurodevelopmental impairment.
FIGURE 9
FIGURE 9
Forest plot of the crude risk of cerebral palsy after IVH grade 3 to 4.
FIGURE 10
FIGURE 10
Forest plot of the crude risk of moderate to severe cerebral palsy after IVH grade 3 to 4.
FIGURE 11
FIGURE 11
Forest plot of the crude risk of hearing impairment after IVH grade 3 to 4.
FIGURE 12
FIGURE 12
Forest plot of the crude risk of visual impairment after IVH grade 3 to 4.
See this image and copyright information in PMC

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