Neurodevelopmental and behavioral outcomes in extremely premature neonates with ventriculomegaly in the absence of periventricular-intraventricular hemorrhage

Athina Pappas, Ira Adams-Chapman, Seetha Shankaran, Scott A. McDonald, Barbara J. Stoll, Abbot R. Laptook, Waldemar A. Carlo, Krisa P. Van Meurs, Susan R. Hintz, Martha D. Carlson, Jane E. Brumbaugh, Michele C. Walsh, Myra H. Wyckoff, Abhik Das, Rosemary D. Higgins, Michael S. Caplan, Richard A. Polin, Martin Keszler, William Oh, Betty R. VohrAngelita M. Hensman, Kristin M. Basso, Barbara Alksninis, Robert Burke, Melinda Caskey, Andrea Halbrook, Katharine Johnson, Mary Lenore Keszler, Theresa M. Leach, Bonnie E. Stephens, Suzy Ventura, Victoria E. Watson, Avroy A. Fanaroff, Anna Marie Hibbs, Deanne E. Wilson-Costello, Nancy S. Newman, Allison F. Payne, Bonnie S. Siner, Monika Bhola, Gulgun Yalcinkaya, Harriet G. Friedman, William E. Truog, Eugenia K. Pallotto, Howard W. Kilbride, Cheri Gauldin, Anne Holmes, Kathy Johnson, Kurt Schibler, Edward F. Donovan, Cathy Grisby, Barbara Alexander, Kate Bridges, Estelle E. Fischer, Teresa L. Gratton, Holly L. Mincey, Greg Muthig, Jody Hessling, Lenora D. Jackson, Kristin Kirker, Kimberly Yolton, Ronald N. Goldberg, C. Michael Cotten, Ricki F. Goldstein, Kathryn E. Gustafson, Joanne Finkle, Patricia L. Ashley, William F. Malcolm, Kathy J. Auten, Kimberley A. Fisher, Katherine A. Foy, Sandra Grimes, Melody B. Lohmeyer, Matthew M. Laughon, Carl L. Bose, Janice Bernhardt, Gennie Bose, Janice K. Wereszczak, David P. Carlton, Ellen C. Hale, Yvonne C. Loggins, Maureen Mulligan LaRossa, Sheena L. Carter, Stephanie Wilson Archer, Gregory M. Sokol, Brenda B. Poindexter, Anna M. Dusick, Lu Ann Papile, Dianne E. Herron, Lucy C. Miller, Carolyn Lytle, Ann B. Cook, Heike M. Minnich, Abbey C. Hines, Leslie Dawn Wilson, Faithe Hamer, Pablo J. Sánchez, Leif D. Nelin, Sudarshan R. Jadcherla, Keith Owen Yeates, Patricia Luzader, Christine A. Fortney, Gail E. Besner, Nehal A. Parikh, Dennis Wallace, W. Kenneth Poole, Jeanette O.Donnell Auman, Margaret M. Crawford, Marie G. Gantz, Jamie E. Newman, Carolyn M. Petrie Huitema, Kristin M. Zaterka-Baxter, David K. Stevenson, M. Bethany Ball, Marian M. Adams, Barbara Bentley, Elizabeth Bruno, Maria Elena DeAnda, Anne M. DeBattista, Lynne C. Huffman, Jean G. Kohn, Casey E. Krueger, Andrew W. Palmquist, Melinda S. Proud, Brian Tang, Hali E. Weiss, Ivan D. Frantz, John M. Fiascone, Elisabeth C. McGowan, Brenda L. MacKinnon, Ana K. Brussa, Anne Furey, Ellen Nylen, Cecelia E. Sibley, Namasivayam Ambalavanan, Myriam Peralta-Carcelen, Monica V. Collins, Shirley S. Cosby, Vivien A. Phillips, Fred J. Biasini, Kristy Domnanovich, Kristen C. Johnston, Carin Kiser, Sara Kryzwanski, Kathleen G. Nelson, Cryshelle S. Patterson, Richard V. Rector, Leslie Rodrigues, Sarah Ryan, Leigh Ann Smith, Amanda D. Soong, Sally Whitley, Uday Devaskar, Meena Garg, Isabell B. Purdy, Teresa Chanlaw, Rachel Geller, Neil N. Finer, David Kaegi, Maynard R. Rasmussen, Yvonne E. Vaucher, Kathy Arnell, Clarence Demetrio, Martha G. Fuller, Chris Henderson, Wade Rich, Radmila West, Edward F. Bell, Dan L. Ellsbury, John A. Widness, Tarah T. Colaizy, Michael J. Acarregui, Karen J. Johnson, Donia B. Campbell, Diane L. Eastman, Jacky R. Walker, Shahnaz Duara, Charles R. Bauer, Ruth Everett-Thomas, Sylvia Fajardo-Hiriart, Arielle Rigaud, Maria Calejo, Silvia M. Frade Eguaras, Michelle Harwood Berkowits, Andrea Garcia, Helina Pierre, Alexandra Stoerger, Kristi L. Watterberg, Robin K. Ohls, Andrea H. Duncan, Janell F. Fuller, Conra Backstrom Lacy, Sandra Brown, Carol Hartenberger, Jean R. Lowe, Rebecca A. Montman, Barbara Schmidt, Haresh Kirpalani, Sara B. DeMauro, Aasma S. Chaudhary, Soraya Abbasi, Toni Mancini, Dara M. Cucinotta, Judy C. Bernbaum, Marsha Gerdes, Hallam Hurt, Carl T. D'Angio, Dale L. Phelps, Ronnie Guillet, Gary J. Myers, Linda J. Reubens, Erica Burnell, Diane Hust, Julie Babish Johnson, Julianne Hunn, Rosemary L. Jensen, Emily Kushner, Deanna Maffett, Joan Merzbach, Holly I.M. Wadkins, Kelley Yost, Lauren Zwetsch, Satyan Lakshminrusimha, Anne Marie Reynolds, Farooq Osman, Ashley Williams, Karen Wynn, Kathleen A. Kennedy, Jon E. Tyson, Georgia E. McDavid, Nora I. Alaniz, Katrina Burson, Patricia W. Evans, Charles Green, Beverly Foley Harris, Margarita Jiminez, Anna E. Lis, Sarah Martin, Brenda H. Morris, M. Layne Poundstone, Peggy Robichaux, Saba Siddiki, Maegan C. Simmons, Patti L. Pierce Tate, Sharon L. Wright, Luc P. Brion, Roy J. Heyne, Walid A. Salhab, Charles R. Rosenfeld, Diana M. Vasil, Sally S. Adams, Lijun Chen, Alicia Guzman, Gaynelle Hensley, Elizabeth T. Heyne, Melissa H. Leps, Linda A. Madden, Nancy A. Miller, Janet S. Morgan, Lizette E. Torres, Catherine Twell Boatman, Roger G. Faix, Bradley A. Yoder, Anna Bodnar, Karen A. Osborne, Shawna Baker, Karie Bird, Jill Burnett, Laura Cole, Jennifer J. Jensen, Cynthia Spencer, Michael Steffen, Kimberlee Weaver-Lewis, Sarah Winter, Karen Zanetti, T. Michael O'Shea, Robert G. Dillard, Lisa K. Washburn, Barbara G. Jackson, Nancy Peters, Korinne Chiu, Deborah Evans Allred, Donald J. Goldstein, Raquel Halfond, Carroll Peterson, Ellen L. Waldrep, Cherrie D. Welch, Melissa Whalen Morris, Gail Wiley Hounshell, John Barks, Rebecca Bara, Angela Argento, Laura A. Goldston, Mary Johnson, Mary Christensen, Stephanie Wiggins, Richard A. Ehrenkranz, Harris Jacobs, Christine G. Butler, Patricia Cervone, Sheila Greisman, Monica Konstantino, Joann Poulsen, Janet Taft, Joanne Williams, Elaine Romano

Research output: Contribution to journalArticle

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Abstract

IMPORTANCE Studies of cranial ultrasonography and early childhood outcomes among cohorts of extremely preterm neonates have linked periventricular-intraventricular hemorrhage and cystic periventricular leukomalacia with adverse neurodevelopmental outcomes. However, the association between nonhemorrhagic ventriculomegaly and neurodevelopmental and behavioral outcomes is not fully understood. OBJECTIVE To characterize the outcomes of extremely preterm neonates younger than 27 weeks' gestational age who experienced nonhemorrhagic ventriculomegaly that was detected prior to 36 weeks' postmenstrual age. DESIGN, SETTING, AND PARTICIPANTS This longitudinal observational studywas conducted at 16 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants born prior to 27 weeks' gestational age in any network facility between July 1, 2006, and June 30, 2011, were included if they had a cranial ultrasonogram performed prior to 36 weeks' postmenstrual age. Comparisons were made between those with ventriculomegaly and those with normal cranial sonograms. Data analysis was completed from August 2013 to August 2017. MAIN OUTCOMES AND MEASURES The main outcomewas neurodevelopmental impairment, defined as a Bayley Scales of Infant and Toddler Development III cognitive score less than 70, moderate/severe cerebral palsy, a Gross Motor Function Classification System score of level 2 or more, vision impairment, or hearing impairment. Secondary outcomes included Bayley Scales of Infant and Toddler Development III subscores, components of neurodevelopmental impairment, behavioral outcomes, and death/neurodevelopmental impairment. Logistic regression was used to evaluate the association of ventriculomegaly with adverse outcomes while controlling for potentially confounding variables and center differences as a random effect. Linear regression was used similarly for continuous outcomes. RESULTS Of4193neonateswithultrasonographydata,300hadnonhemorrhagicventriculomegaly (7%); 3045 had normal cranial ultrasonograms (73%), 775 had periventricular-intraventricular hemorrhage (18.5%), and 73 had cystic periventricular leukomalacia (1.7%). Outcomeswere available for3008of3345neonateswithventriculomegaly ornormalscans(90%).Comparedwith normal cranial ultrasonograms, ventriculomegalywas associated with lower gestational age, male sex, and bronchopulmonary dysplasia, late-onset sepsis, meningitis, necrotizing enterocolitis, and stage 3 retinopathy of prematurity. After adjustment, neonates with ventriculomegaly had higher odds of neurodevelopmental impairment (odds ratio [OR], 3.07; 95%CI, 2.13-4.43), cognitive impairment (OR, 3.23; 95%CI, 2.09-4.99), moderate/severe cerebral palsy (OR, 3.68; 95%CI, 2.08-6.51),death/neurodevelopmentalimpairment(OR,2.17;95%CI,1.62-2.91),butnotdeathalone (OR, 1.09; 95%CI,0.76-1.57). Behavioral outcomes did not differ. CONCLUSIONS AND RELEVANCE Nonhemorrhagic ventriculomegaly is associated with increased odds of neurodevelopmental impairment among extremely preterm neonates.

Original languageEnglish (US)
Pages (from-to)32-42
Number of pages11
JournalJAMA pediatrics
Volume172
Issue number1
DOIs
StatePublished - Jan 2018

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Pappas, A., Adams-Chapman, I., Shankaran, S., McDonald, S. A., Stoll, B. J., Laptook, A. R., Carlo, W. A., Van Meurs, K. P., Hintz, S. R., Carlson, M. D., Brumbaugh, J. E., Walsh, M. C., Wyckoff, M. H., Das, A., Higgins, R. D., Caplan, M. S., Polin, R. A., Keszler, M., Oh, W., ... Romano, E. (2018). Neurodevelopmental and behavioral outcomes in extremely premature neonates with ventriculomegaly in the absence of periventricular-intraventricular hemorrhage. JAMA pediatrics, 172(1), 32-42. https://doi.org/10.1001/jamapediatrics.2017.3545