Predictors of Severe Neurologic Injury on Ultrasound Scan of the Head and Risk Factor-based Screening for Infants Born Preterm
To identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed by ultrasound scan of the head among infants born at 300-326 weeks of gestation and compare different screening strategies. This was a retrospective co...
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Published in | The Journal of pediatrics Vol. 214; pp. 27 - 33.e3 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Elsevier Inc
01.11.2019
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Abstract | To identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed by ultrasound scan of the head among infants born at 300-326 weeks of gestation and compare different screening strategies.
This was a retrospective cohort study of infants born at 300-326 weeks or >326 weeks of gestation with a birth weight <1500 g admitted to neonatal intensive care units in the Canadian Neonatal Network from 2011 to 2016. Stepwise logistic regression analysis was used to identify significant risk factors and calculate aORs and 95% CIs. Risk factor-based screening strategies were compared.
The rate of severe neurologic injury was 3.1% among infants screened (285/9221). Significant risk factors included singleton birth (aOR 1.96, 95% CI 1.35-2.85), 5-minute Apgar <7 (aOR 1.81, 95% CI 1.30-2.50), mechanical ventilation on day 1 (aOR 2.65, 95% CI 1.88-3.71), and treatment with vasopressors on day 1 (aOR 3.23, 95% CI 2.19-4.75). Risk categories were low (no risk factor, 1.2%, 25/2137), moderate (singleton with no other risk factor: 1.8%, 68/3678), and high (≥1 risk factor among 5-minute Apgar <7, receipt of vasopressors or mechanical ventilation on day 1: 5.6%, 192/3408). Screening moderate- to high-risk infants identified 91% (260/285) of infants with severe neurologic injury and would require screening fewer infants (1647 infants per year) than screening all infants <33 weeks of gestation (2064 infants screened per year, 93% [265/285] of cases identified).
Risk factor-based ultrasound scan of the head screening among infants born at 30-32 weeks of gestation could help optimize resources better than gestational age based screening. |
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AbstractList | To identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed by ultrasound scan of the head among infants born at 30
-32
weeks of gestation and compare different screening strategies.
This was a retrospective cohort study of infants born at 30
-32
weeks or >32
weeks of gestation with a birth weight <1500 g admitted to neonatal intensive care units in the Canadian Neonatal Network from 2011 to 2016. Stepwise logistic regression analysis was used to identify significant risk factors and calculate aORs and 95% CIs. Risk factor-based screening strategies were compared.
The rate of severe neurologic injury was 3.1% among infants screened (285/9221). Significant risk factors included singleton birth (aOR 1.96, 95% CI 1.35-2.85), 5-minute Apgar <7 (aOR 1.81, 95% CI 1.30-2.50), mechanical ventilation on day 1 (aOR 2.65, 95% CI 1.88-3.71), and treatment with vasopressors on day 1 (aOR 3.23, 95% CI 2.19-4.75). Risk categories were low (no risk factor, 1.2%, 25/2137), moderate (singleton with no other risk factor: 1.8%, 68/3678), and high (≥1 risk factor among 5-minute Apgar <7, receipt of vasopressors or mechanical ventilation on day 1: 5.6%, 192/3408). Screening moderate- to high-risk infants identified 91% (260/285) of infants with severe neurologic injury and would require screening fewer infants (1647 infants per year) than screening all infants <33 weeks of gestation (2064 infants screened per year, 93% [265/285] of cases identified).
Risk factor-based ultrasound scan of the head screening among infants born at 30-32 weeks of gestation could help optimize resources better than gestational age based screening. To identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed by ultrasound scan of the head among infants born at 300-326 weeks of gestation and compare different screening strategies. This was a retrospective cohort study of infants born at 300-326 weeks or >326 weeks of gestation with a birth weight <1500 g admitted to neonatal intensive care units in the Canadian Neonatal Network from 2011 to 2016. Stepwise logistic regression analysis was used to identify significant risk factors and calculate aORs and 95% CIs. Risk factor-based screening strategies were compared. The rate of severe neurologic injury was 3.1% among infants screened (285/9221). Significant risk factors included singleton birth (aOR 1.96, 95% CI 1.35-2.85), 5-minute Apgar <7 (aOR 1.81, 95% CI 1.30-2.50), mechanical ventilation on day 1 (aOR 2.65, 95% CI 1.88-3.71), and treatment with vasopressors on day 1 (aOR 3.23, 95% CI 2.19-4.75). Risk categories were low (no risk factor, 1.2%, 25/2137), moderate (singleton with no other risk factor: 1.8%, 68/3678), and high (≥1 risk factor among 5-minute Apgar <7, receipt of vasopressors or mechanical ventilation on day 1: 5.6%, 192/3408). Screening moderate- to high-risk infants identified 91% (260/285) of infants with severe neurologic injury and would require screening fewer infants (1647 infants per year) than screening all infants <33 weeks of gestation (2064 infants screened per year, 93% [265/285] of cases identified). Risk factor-based ultrasound scan of the head screening among infants born at 30-32 weeks of gestation could help optimize resources better than gestational age based screening. OBJECTIVETo identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed by ultrasound scan of the head among infants born at 300-326 weeks of gestation and compare different screening strategies. STUDY DESIGNThis was a retrospective cohort study of infants born at 300-326 weeks or >326 weeks of gestation with a birth weight <1500 g admitted to neonatal intensive care units in the Canadian Neonatal Network from 2011 to 2016. Stepwise logistic regression analysis was used to identify significant risk factors and calculate aORs and 95% CIs. Risk factor-based screening strategies were compared. RESULTSThe rate of severe neurologic injury was 3.1% among infants screened (285/9221). Significant risk factors included singleton birth (aOR 1.96, 95% CI 1.35-2.85), 5-minute Apgar <7 (aOR 1.81, 95% CI 1.30-2.50), mechanical ventilation on day 1 (aOR 2.65, 95% CI 1.88-3.71), and treatment with vasopressors on day 1 (aOR 3.23, 95% CI 2.19-4.75). Risk categories were low (no risk factor, 1.2%, 25/2137), moderate (singleton with no other risk factor: 1.8%, 68/3678), and high (≥1 risk factor among 5-minute Apgar <7, receipt of vasopressors or mechanical ventilation on day 1: 5.6%, 192/3408). Screening moderate- to high-risk infants identified 91% (260/285) of infants with severe neurologic injury and would require screening fewer infants (1647 infants per year) than screening all infants <33 weeks of gestation (2064 infants screened per year, 93% [265/285] of cases identified). CONCLUSIONSRisk factor-based ultrasound scan of the head screening among infants born at 30-32 weeks of gestation could help optimize resources better than gestational age based screening. |
Author | Lapoint, Anie Beltempo, Marc Dunn, Michael Masse, Edith Lee, Shoo K. Lemyre, Brigitte Shalish, Wissam Lee, Kyong-Soon Piedboeuf, Bruno Yee, Wendy Barrington, Keith Wintermark, Pia Fajardo, Carlos Shah, Prakesh S. Toye, Jennifer Daspal, Sibasis Makary, Hala Guillot, Mireille Monterrosa, Luis Claveau, Martine Kalapesi, Zarin Ojah, Cecil Kanungo, Jaideep Narvey, Michael Ng, Eugene H. Dow, Kimberly Drolet, Christine Kajetanowicz, Andrzej Da Silva, Orlando Ting, Joseph Afifi, Jehier Pelausa, Ermelinda Nwaesei, Chuks Cieslak, Zenon Alvaro, Ruben Emberley, Julie Sherlock, Rebecca Canning, Roderick Martel-Bucci, Andrea Seshia, Mary Bertelle, Valerie Sankaran, Koravangattu Mukerji, Amit |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31377043$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1055_s_0040_1718577 crossref_primary_10_1016_j_earlhumdev_2021_105309 crossref_primary_10_1080_14767058_2022_2128647 crossref_primary_10_1002_jum_16121 crossref_primary_10_5005_jp_journals_11002_0097 crossref_primary_10_1016_j_jpeds_2024_113976 crossref_primary_10_1016_j_siny_2020_101106 crossref_primary_10_3390_jcm11071866 crossref_primary_10_5385_nm_2022_29_2_57 crossref_primary_10_1038_s41390_023_02993_5 crossref_primary_10_1016_j_semperi_2021_151472 crossref_primary_10_3389_fped_2021_618236 crossref_primary_10_3390_children7110216 crossref_primary_10_1136_bcr_2021_244685 crossref_primary_10_1016_j_earlhumdev_2020_105094 |
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ContentType | Journal Article |
Contributor | Lapoint, Anie Dunn, Michael Masse, Edith Lee, Shoo K Lee, Kyong-Soon Piedboeuf, Bruno Yee, Wendy Barrington, Keith Fajardo, Carlos Toye, Jennifer Daspal, Sibasis Makary, Hala Monterrosa, Luis Claveau, Martine Kalapesi, Zarin Ojah, Cecil Kanungo, Jaideep Dow, Kimberly Drolet, Christine Kajetanowicz, Andrzej Da Silva, Orlando Ting, Joseph Afifi, Jehier Pelausa, Ermelinda Nwaesei, Chuks Cieslak, Zenon Alvaro, Ruben Emberley, Julie Sherlock, Rebecca Canning, Roderick Seshia, Mary Bertelle, Valerie Sankaran, Koravangattu Mukerji, Amit |
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Copyright | 2019 Elsevier Inc. Copyright © 2019 Elsevier Inc. All rights reserved. |
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CorporateAuthor | Canadian Neonatal Network Investigators |
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Keywords | premature brain injury head ultrasound CNN periventricular leukomalacia intraventricular hemorrhage PVL preterm NICU IVH infant NNM |
Language | English |
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routine head ultrasounds in preterm infants with gestational age 30-34 weeks publication-title: J Matern Fetal Neonatal Med doi: 10.3109/14767058.2011.557755 contributor: fullname: Bhat – volume: 24 start-page: 170 year: 2013 ident: 10.1016/j.jpeds.2019.06.065_bib20 article-title: Number needed to misdiagnose: a measure of diagnostic test effectiveness publication-title: Epidemiology doi: 10.1097/EDE.0b013e31827825f2 contributor: fullname: Habibzadeh |
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Snippet | To identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed by... OBJECTIVETo identify risk factors for severe neurologic injury (intraventricular hemorrhage grade 3 or greater and/or periventricular leukomalacia) diagnosed... |
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SubjectTerms | brain injury Cerebral Intraventricular Hemorrhage - diagnostic imaging Cerebral Intraventricular Hemorrhage - etiology Clinical Decision Rules Clinical Decision-Making - methods Female Head - diagnostic imaging head ultrasound Humans infant Infant, Newborn Infant, Premature, Diseases - diagnostic imaging Infant, Premature, Diseases - etiology intraventricular hemorrhage Leukomalacia, Periventricular - diagnostic imaging Leukomalacia, Periventricular - etiology Logistic Models Male Neonatal Screening - methods Odds Ratio periventricular leukomalacia premature preterm Retrospective Studies Risk Assessment Risk Factors Sensitivity and Specificity Severity of Illness Index Ultrasonography |
Title | Predictors of Severe Neurologic Injury on Ultrasound Scan of the Head and Risk Factor-based Screening for Infants Born Preterm |
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