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PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1108-1114

Predictors of Long-Term Outcome in Very Preterm Infants: Gestational Age Versus Neonatal Cranial Ultrasound

Brigitte Vollmer, MD*,{ddagger}, Simon Roth, FRCP, FRCPCH*, Jenny Baudin, PhD*, Ann L. Stewart, FRCP, FRCPCH*, Brian G. R. Neville, FRCP, FRCPH{ddagger} and John S. Wyatt, FRCP, FRCPCH*

* Department of Pediatrics, University College London Medical School, Bloomsbury Campus, London, United Kingdom
{ddagger} Neurosciences Unit, Institute of Child Health, University College London Medical School, Mecklenburgh Square, London, United Kingdom

Objectives. To investigate the effect of gestational age at birth on the frequency of ultrasound-detected brain lesions in infants born at <33 weeks of gestation and to investigate whether the relationship between neonatal cranial ultrasound diagnosis and neurodevelopmental outcome at 8 years of age was independent of gestational age.

Methods. Eight hundred forty-seven infants born at <33 weeks of gestation, admitted to a single tertiary referral center between 1983 and 1988, underwent serial neonatal cranial ultrasound. At 8 years of age neurodevelopmental outcome was assessed by structured neurologic examination, psychometric tests (Wechsler Intelligence Scale for Children), tests of visuomotor integration (Beery) and motor impairment (Henderson-Stott). Infants were subdivided into a group born at <28 weeks and a group born at between 28 and 32 weeks. Neurodevelopmental outcome was analyzed for each ultrasound diagnosis.

Results. Hemorrhagic lesions such as germinal matrix/intraventricular hemorrhage and hemorrhagic parenchymal infarction were more frequent in infants born at <28 weeks. There was no difference in the frequency of cystic periventricular leucomalacia between the 2 groups. When neurodevelopmental outcome for each ultrasound diagnosis was compared, no significant difference was found between the 2 gestational age groups.

Conclusion. In the gestational age range studied, adverse neurodevelopmental outcome depends primarily on the type of the intracranial lesion rather than on gestational age.

Key Words: very preterm infant • neonatal cranial ultrasound • neurodevelopmental outcome • brain lesions • gestational age

Abbreviations: SD, standard deviation • WISC, Wechsler Intelligence Scale for Children • GMH/IVH, germinal matrix/intraventricular hemorrhage • PVL, periventricular leukomalacia • HPI, hemorrhagic parenchymal infarction

Received for publication Nov 28, 2001; Accepted Apr 10, 2003.




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