Heather Campbell1, Jennifer Check2, Karl C K Kuban3, Alan Leviton4, Robert M Joseph5, Jean A Frazier6, Laurie M Douglass3, Kyle Roell1, Elizabeth N Allred4, Lynn Ansley Fordham7, Stephen R Hooper8, Hernan Jara9, Nigel Paneth10, Irina Mokrova11, Hongyu Ru1, Hudson P Santos12, Rebecca C Fry13, T Michael O'Shea14. 1. Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC. 2. Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC. 3. Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, Boston, MA. 4. Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA. 5. Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA. 6. Eunice Kennedy Shriver Center, University of Massachusetts Medical School, Worcester, MA. 7. Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC. 8. Department of Allied Health, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC. 9. Department of Radiology, Boston University Medical Center, Boston, MA. 10. Michigan State University College of Human Medicine, East Lansing, MI. 11. Duke University School of Medicine, Durham, NC. 12. Biobehavioral Laboratory, School of Nursing, University of North Carolina, Chapel Hill, NC. 13. Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC. 14. Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC. Electronic address: moshea52@email.unc.edu.
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.
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.
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