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J Pediatr. 2018 Apr;195:66-72.e3. doi: 10.1016/j.jpeds.2017.11.036. Epub 2018 Feb 1.

Antecedents and Outcomes of Abnormal Cranial Imaging in Moderately Preterm Infants.

Author information

1
Wayne State University, Detroit, MI. Electronic address: gnatara@med.wayne.edu.
2
Wayne State University, Detroit, MI.
3
RTI International, Research Triangle Park, NC.
4
Women and Infants Hospital of Rhode Island, Providence, RI.
5
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.
6
Department of Pediatrics, UT Health McGovern Medical School, Houston, TX.
7
Department of Pediatrics, University of Iowa, Iowa City, IA.
8
Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL.
9
University of Rochester Medical Center, Rochester, NY.
10
Department of Pediatrics, University of Pennsylvania, PA.
11
Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH.
12
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine and Lucile Packard Children's Hospital, Palo Alto, CA.
13
Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH.
14
Emory University, Atlanta, GA.
15
Division of Neonatology, College of Physicians and Surgeons, Columbia University.
16
Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island.
17
Case Western Reserve University, Rainbow Babies & Children's Hospital.
18
Children's Mercy Hospital.
19
Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical Center, Good Samaritan Hospital.
20
Duke University School of Medicine, University Hospital, University of North Carolina, Duke Regional Hospital.
21
Emory University, Children's Healthcare of Atlanta, Grady Memorial Hospital, Emory University Hospital Midtown.
22
Eunice Kennedy Shriver National Institute of Child Health and Human Development.
23
Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children at Indiana University Health, Eskenazi Health.
24
Nationwide Children's Hospital and the Ohio State University Medical Center.
25
RTI International.
26
Stanford University and Lucile Packard Children's Hospital.
27
University of Alabama at Birmingham Health System and Children's Hospital of Alabama.
28
University of California - Los Angeles, Mattel Children's Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center, Olive View Medical Center.
29
University of Iowa and Mercy Medical Center.
30
University of New Mexico Health Sciences Center.
31
University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital, Children's Hospital of Philadelphia.
32
University of Rochester Medical Center, Golisano Children's Hospital, University of Buffalo Women's and Children's Hospital of Buffalo.
33
University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System, Children's Medical Center Dallas.
34
University of Texas Health Science Center, Houston Medical School, Children's Memorial Hermann Hospital.
35
Wayne State University, University of Michigan, Hutzel Women's Hospital, Children's Hospital of Michigan.

Abstract

OBJECTIVES:

To describe the frequency and findings of cranial imaging in moderately preterm infants (born at 290/7-336/7 weeks of gestation) across centers, and to examine the association between abnormal imaging and clinical characteristics.

STUDY DESIGN:

We used data from the Neonatal Research Network Moderately Preterm Registry, including the most severe early (≤28 days) and late (>28 days) cranial imaging. Stepwise logistic regression and CART analysis were performed after adjustment for gestational age, antenatal steroid use, and center.

RESULTS:

Among 7021 infants, 4184 (60%) underwent cranial imaging. These infants had lower gestational ages and birth weights and higher rates of small for gestational age, outborn birth, cesarean delivery, neonatal resuscitation, and treatment with surfactant, compared with those without imaging (P < .0001). Imaging abnormalities noted in 15% of the infants included any intracranial hemorrhage (13.2%), grades 3-4 intracranial hemorrhage (1.7%), cystic periventricular leukomalacia (2.6%), and ventriculomegaly (6.6%). Histologic chorioamnionitis (OR, 1.47; 95% CI, 1.19-1.83), gestational age (0.95; 95% CI, 0.94-0.97), antenatal steroids (OR, 0.55; 95% CI, 0.41-0.74), and cesarean delivery (OR, 0.66; 95% CI, 0.53-0.81) were associated with abnormal imaging. The center with the highest rate of cranial imaging, compared with the lowest, had a higher risk of abnormal imaging (OR, 2.08; 95% CI, 1.10-3.92). On the classification and regression-tree model, cesarean delivery, center, antenatal steroids, and chorioamnionitis, in that order, predicted abnormal imaging.

CONCLUSION:

Among the 60% of moderately preterm infants with cranial imaging, 15% had intracranial hemorrhage, cystic periventricular leukomalacia or late ventriculomegaly. Further correlation of imaging and long-term neurodevelopmental outcomes in moderately preterm infants is needed.

KEYWORDS:

intracranial hemorrhage; moderate preterm; periventricular leukomalacia; ultrasound

PMID:
29395186
PMCID:
PMC5869095
[Available on 2019-04-01]
DOI:
10.1016/j.jpeds.2017.11.036

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