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PEDIATRICS Vol. 104 No. 2 August 1999, pp. 243-248

The Etiology and Outcome of Cerebral Ventriculomegaly at Term in Very Low Birth Weight Preterm Infants

Received Jul 8, 1998; accepted Dec 21, 1998.

Laura R. Ment*, Dagger , Betty Vohr§, Walter Allanparallel , Michael Westerveld, Karol H. Katz#, Karen C. Schneider*, and Robert W. Makuch#

From the Departments of * Pediatrics and Dagger  Neurology, Yale University School of Medicine, New Haven, Connecticut; the Department of § Pediatrics, Brown University School of Medicine, Providence, Rhode Island; the Departments of parallel  Pediatrics and Neurology, Maine Medical Center, Portland, Maine; the Departments of  Neurosurgery and # Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut.

Background.  Despite improvements in survival data, the incidence of neurodevelopmental handicaps in preterm infants remains high. To prevent these handicaps, one must understand the pathophysiology behind them. For preterm infants, cerebral ventriculomegaly (VM) may be associated with adverse neurodevelopmental outcome. We hypothesized that although the causes of VM are multiple, the incidence of handicap at 4.5 years of age in preterm infants with this ultrasonographic finding at term would be high.

Methods.  To test this hypothesis, we provided neurodevelopmental follow-up for all 440 very low birth weight survivors of the Multicenter Randomized Indomethacin Intraventricular Hemorrhage (IVH) Prevention Trial. A total of 384 children (87%) were evaluated at 54 months' corrected age (CA), and 257 subjects were living in English-speaking, monolingual households and are included in the following data analysis.

Results.  Moderate to severe low pressure VM at term was documented in 11 (4%) of the English-speaking, monolingual survivors. High grade IVH and bronchopulmonary dysplasia (BPD) were both risk factors for the development of VM. Of 11 (45%) children with VM, 5 suffered grades 3 to 4 IVH, compared with 2/246 (1%) children without VM who experienced grades 3 to 4 IVH. Similarly, 9/11 (82%) children with VM had BPD, compared with 120/246 (49%) children without VM who had BPD.Logistic regression analysis was performed using birth weight, gestational age, gender, Apgar score at 5 minutes, BPD, sepsis, moderate to severe VM, periventricular leukomalacia, grade of IVH, and maternal education to predict IQ <70. Although maternal education was an important and independent predictor of adverse cognitive outcome, in this series of very low birth weight prematurely born children, VM was the most important predictor of IQ <70 (OR: 19.0; 95% CI: 4.5, 80.6). Of children with VM, 6/11 (55%) had an IQ <70, compared with 31/246 (13%) of children without VM. Children with VM had significantly lower verbal and performance scores compared with children without VM.

Conclusions.  These data suggest that, for preterm neonates, VM at term is a consequence of the vulnerability of the developing brain. Furthermore, its presence is an important and independent predictor of adverse cognitive and motor development at 4.5 years' CA.  Key words:  ventriculomegaly, preterm infant, neurodevelopmental outcome, intraventricular hemorrhage, bronchopulmonary dysplasia.




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