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J Perinatol. 2013 Jan;33(1):25-32. doi: 10.1038/jp.2012.91. Epub 2012 Jul 19.

Influence of gestational age on death and neurodevelopmental outcome in premature infants with severe intracranial hemorrhage.

Collaborators (185)

Jobe AH, Oh W, Laptook AR, Vohr BR, Alksninis B, Hensman AM, Leach TM, Leonard MR, Noel L, Vogt RA, Watson VE, Walsh MC, Fanaroff AA, Newman NS, Siner BS, Friedman HG, Donovan EF, Steichen JJ, Alexander B, Grisby C, Worley Mersmann M, Mincey HL, Hessling J, Gratton TL, Goldberg RN, Auten KJ, Gustafson KE, Lohmeyer MB, Stoll BJ, Adams-Chapman I, Carter S, Dinkins E, Hale EC, LaRossa MM, Smikle GV, Wright LL, McClure EM, Poindexter BB, Lemons JA, Bull M, Dusick AM, Kardatzke D, Lytle C, Appel DD, Bohnke LG, Eaken G, Herron DE, Miller LC, Minnich HM, Richard L, Wilson LD, Das A, Poole WK, Hastings B, McClure EM, O'Donnell Auman J, Huitema CM, Schaefer SE, Stevenson DK, Van Meurs KP, Ahlfors CE, Kohn JG, Sivakumar D, Ball MB, Stebbins RD, Kuelper CG, Lee-Ancajas JC, Baran JM, Bond LE, Brudos GK, DeBattista AM, Pyle RP, St John NH, Carlo WA, Peralta-Carcelen M, Nelson KG, Bailey KJ, Biasini FJ, Chopko SA, Collins MV, Cosby SS, Moses MB, Phillips VA, Preskitt J, Rector RV, Whitley S, Finer NN, Vaucher YE, Rasmussen MR, Wozniak PR, Arnell K, Bridge R, Demetrio C, Fuller MG, Posin D, Rich W, Duara S, Bauer CR, Allison M, Everett-Thomas R, Diaz AN, Mathews EO, Hamlin-Smith K, Jean-Gilles L, Calejo M, Frade Eguaras SM, Hiriart-Fajardo S, Gideon YC, Papile LA, Lacy CB, Lowe JR, Phelps DL, Myers G, Burnell E, Rowan M, Johnson JB, Hust D, Jensen RL, Kushner E, Merzbach J, Reubens L, Zwetsch L, Korones SB, Bada HS, Hudson T, Williams M, Yolton K, Laptook AR, Rosenfeld CR, Salhab WA, Broyles RS, Heyne RJ, Adams SS, Boatman CT, Dooley C, Guzman A, Heyne E, Hickman JF, Madden LA, Miller NA, Morgan JS, Madison S, Hensley G, Kennedy K, Tyson JE, Bradt PJ, Major-Kincade T, Morris BH, Whitely LL, Akpa EG, Alaniz NI, Cedillo M, Cluff PA, Dieterich S, Franco CI, Lis AE, McDavid GE, Tate PL, O'Shea TM, Dillard RG, Peters NJ, Chiu K, Allred DE, Goldstein DJ, Halfond R, Jackson BG, Peterson C, Waldrep EL, Morris MW, Hounshell GW, Johnson YR, Bara R, Driscoll D, Goldston L, Kennedy D, Muran G, Ehrenkranz RA, Gettner P, Close N, Gilliam W, Konstantino M, Poulsen J, Romano E, Taft J, Williams J.

Author information

1
Division of Neonatology, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA. golds005@mc.duke.edu

Abstract

OBJECTIVE:

To determine whether death and/or neurodevelopmental impairment (NDI) after severe intracranial hemorrhage (ICH; grade 3 or 4) differs by gestational age (GA) at birth in extremely low birth weight (ELBW) infants.

STUDY DESIGN:

Demographic, perinatal and neonatal factors potentially contributing to NDI for ELBW infants (23 to 28 weeks gestation) were obtained retrospectively; outcome data came from the ELBW Follow-up Study. NDI was defined at 18 to 22 months corrected age as moderate/severe cerebral palsy, Bayley Scales of Infant Development II cognitive or motor score <70, and/or blindness or deafness. Characteristics of younger versus older infants with no versus severe ICH associated with death or NDI were compared. Generalized linear mixed models predicted death or NDI in each GA cohort.

RESULT:

Of the 6638 infants, 61.8% had no ICH and 13.6% had severe ICH; 39% of survivors had NDI. Risk-adjusted odds of death or NDI and death were higher in the lower GA group. Lower GA increased the odds of death before 30 days for infants with severe ICH. Necrotizing enterocolitis (particularly surgical NEC), late onset infection, cystic periventricular leukomalacia and post-natal steroids contributed to mortality risk. NDI differed by GA in infants without ICH and grade 3, but not grade 4 ICH. Contributors to NDI in infants with severe ICH included male gender, surgical NEC and post-hemorrhagic hydrocephalus requiring a shunt.

CONCLUSION:

GA contributes to the risk of death in ELBW infants, but not NDI among survivors with severe ICH. Male gender, surgical NEC and need for a shunt add additional risk for NDI.

PMID:
22814942
PMCID:
PMC3777699
DOI:
10.1038/jp.2012.91
[Indexed for MEDLINE]
Free PMC Article

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