Low-grade intraventricular hemorrhage and neurodevelopment at 24 months of age
DOI:
https://doi.org/10.15448/1980-6108.2018.3.29354Palavras-chave:
hemorragia cerebral intraventricular, recém-nascido prematuro, transtornos do neurodesenvolvimento.Resumo
***Hemorragia intraventricular de baixo grau e neurodesenvolvimento aos 24 meses de idade***
OBJETIVOS: Avaliar o impacto da hemorragia intraventricular de baixo grau no neurodesenvolvimento de lactentes prematuros aos 24 meses de idade.
MÉTODOS: Foi conduzido um estudo de caso-controle retrospectivo em lactentes com idade gestacional inferior a 34 semanas, internados em uma Unidade de Terapia Intensiva Neonatal entre janeiro de 2006 e dezembro de 2015. Os casos foram definidos como aqueles com hemorragia intraventricular de baixo grau (graus I ou II), diagnosticada por ultrassonografia craniana. Para cada caso, foi selecionado um controle com a mesma idade gestacional, mas sem hemorragia intraventricular. A avaliação do neurodesenvolvimento foi realizada aos 24 meses de idade, em casos e controles, com a Escala de Desenvolvimento Mental de Griffiths. Paralisia cerebral, atraso no neurodesenvolvimento (quociente de desenvolvimento <2 desvios padrões abaixo da média para a idade), deficiência auditiva e/ou cegueira foram considerados comprometimento grave do neurodesenvolvimento.
RESULTADOS: O estudo incluiu 172 prematuros: 86 casos e 86 controles. Na análise univariada, identificou-se diferença entre os dois grupos para os seguintes achados clínicos: ciclo completo de corticosteroide pré-natal (57% nos casos vs. 80% nos controles; p=0,001; OR: 0,33; IC95% 0,17-0,64); sexo masculino (63% casos vs. 41% controles; p=0,004; OR: 2,45, IC95% 1,3-4,5); nascidos em outro hospital (26% casos vs. 9% controles; p=0,005; OR: 3,3 IC95% 1,4-8,0); Índice de Risco Clínico para Bebês acima de 5 (24% nos casos vs. 12% nos controles; p=0,029; OR: 2,4 IC95% 1,1-5,6); intubação na sala de parto (47% casos vs. 27% controles; p=0,007; OR: 2,38; IC95%: 1,3-4,5); e sepse neonatal (34% nos casos vs. 20% nos controlos; p=0,039; OR: 2,1 95% CI 1,03-4,1). Após a regressão logística, as diferenças foram mantidas apenas para o corticosteróide antenatal (p=0,005; OR 0,34, IC 95% 0,16-0,72) e sexo masculino (p=0,002; OR 2,9, IC95% 1,4-5,8). Um déficit grave de neurodesenvolvimento esteve presente em três casos (3,5%) e um controle (1,2%). Não houve diferenças estatisticamente significativas no desfecho entre casos e controles.
CONCLUSÕES: Nesta amostra, os prematuros com hemorragia intraventricular de baixo grau diagnosticados pela ultrassonografia craniana não apresentaram diferença no desenvolvimento neurológico precoce quando comparados aos controles.
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Referências
Kenet G, Kuperman AA, Strauss T, Brenner B. Neonatal IVH – mechanisms and management. Thromb Res. 2011;127 Suppl 3:S120-2. https://doi.org/10.1016/S0049-3848(11)70032-9
Ballabh P. Intraventricular hemorrhage in premature infants: mechanism of disease. Pediatr Res. 2010;67(1):1-8. https://doi.org/10.1203/PDR.0b013e3181c1b176
Owens R. Intraventricular hemorrhage in the premature neonate. Neonatal Netw. 2005;24(3):55-71. https://doi.org/10.1891/0730-0832.24.3.55
Larroque B, Marret S, Ancel PY, Arnaud C, Marpeau L, Supernant K, Pierrat V, Rozé JC, Matis J, Cambonie G, Burguet A, Andre M, Kaminski M, Bréart G. White matter damage and intraventricular hemorrhage in very preterm infants: the EPIPAGE study. J Pediatr. 2003;143(4):477-83. https://doi.org/10.1067/S0022-3476(03)00417-7
Patra K, Wilson-Costello D, Taylor HG, Mercuri-Minich N, Hack M. Grades I-II intraventricular hemorrhage in extremely low birth weight infants: effects on neurodevelopment. J Pediatr. 2006;149(2):169-73. https://doi.org/10.1016/j.jpeds.2006.04.002
Cust AE, Darlow BA, Donoghue DA; Australian and New Zealand Neonatal Network (ANZNN). Outcomes for high risk New Zealand newborn infants in 1998-1999: a population based, national study. Arch Dis Child Fetal Neonatal Ed. 2003;88(1):F15-22. https://doi.org/10.1136/fn.88.1.F15
Plaisier A, Raets MM, Ecury-Goossen GM, Govaert P, Feijen-Roon M, Reiss IK, Smit LS, Lequin MH, Dudink J. Serial cranial ultrasonography or early MRI for detecting preterm brain injury? Arch Dis Child Fetal Neonatal Ed. 2015;100(4):F293-300. https://doi.org/10.1136/archdischild-2014-306129
Brouwer A, Groenendaal F, van Haastert IL, Rademaker K, Hanlo P, de Vries L. Neurodevelopmental outcome of preterm infants with severe intraventricular hemorrhage and therapy for post-hemorrhagic ventricular dilatation. J Pediatr. 2008;152(5):648-54. https://doi.org/10.1016/j.jpeds.2007.10.005
Calisici E, Eras Z, Oncel MY, Oguz SS, Gokce IK, Dilmen U. Neurodevelopmental outcomes of premature infants with severe intraventricular hemorrhage. J Matern Fetal Neonatal Med. 2015;28(17):2115-20. https://doi.org/10.3109/14767058.2014.979783
Ann Wy P, Rettiganti M, Li J, Yap V, Barrett K, Whiteside-Mansell L, Casey P. Impact of intraventricular hemorrhage on cognitive and behavioral outcomes at 18 years of age in low birth weight preterm infants. J Perinatol. 2015;35(7):511-5. https://doi.org/10.1038/jp.2014.244
Reubsaet P, Brouwer AJ, van Haastert IC, Brouwer MJ, Koopman C, Groenendaal F, de Vries LS. The Impact of Low-Grade Germinal Matrix-Intraventricular Hemorrhage on Neurodevelopmental Outcome of Very Preterm Infants. Neonatology. 2017;112(3):203-10. https://doi.org/10.1159/000472246
Vohr BR, Allan W, Katz KH, Schneider K, Tucker R, Ment LR. Adolescents born prematurely with isolated grade 2 haemorrhage in the early 1990s face increased risks of learning challenges. Acta Paediatr. 2014;103(10):1066-71. https://doi.org/10.1111/apa.12728
Payne AH, Hintz SR, Hibbs AM, Walsh MC, Vohr BR, Bann CM, Wilson-Costello. Neurodevelopmental outcomes of extremely low-gestational-age neonates with low-grade periventricular-intraventricular hemorrhage. JAMA Pediatr. 2013;167(5):451-9. https://doi.org/10.1001/jamapediatrics.2013.866
Bolisetty S, Dhawan A, Abdel-Latif M, Bajuk B, Stack J, Lui K. Intraventricular hemorrhage and neurodevelopmental outcomes in extreme preterm infants. Pediatrics. 2014;133(1):55-62. https://doi.org/10.1542/peds.2013-0372
O'Shea TM, Allred EN, Kuban KC, Hirtz D, Specter B, Durfee S, Paneth N, Leviton A; ELGAN Study Investigators. Intraventricular hemorrhage and developmental outcomes at 24 months of age in extremely preterm infants. J Child Neurol. 2012;27(1):22-9. https://doi.org/10.1177/0883073811424462
Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92(4):529-34. https://doi.org/10.1016/S0022-3476(78)80282-0
Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33(1):179-201. https://doi.org/10.1016/S0031-3955(16)34975-6
International Committee for the Classification of Retinopathy of P. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123(7):991-9. https://doi.org/10.1001/archopht.123.7.991
Tita AT, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol. 2010;37(2):339-54. https://doi.org/10.1016/j.clp.2010.02.003
Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59. https://doi.org/10.1186/1471-2431-13-59
The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. The International Neonatal Network. Lancet. 1993;342(8865):193-8. https://doi.org/10.1016/0140-6736(93)92296-6
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14.
Luiz D, Faragher B, Barnard A, Knoesen N, Kotras N, L B. Griffiths Mental Developmental Scales Extended Revised. Oxford: Hogrefe; 2006.
Volpe JJ. Intracranial hemorrhage: Germinal matrix hemorrhage. In: Volpe JJ, editor. Neurology of the newborn. 5th edition Philadelphia: Saunders Elsevier; 2008. p. 517-88.
Mohamed MA, Aly H. Male gender is associated with intraventricular hemorrhage. Pediatrics. 2010;125(2):e333-9. https://doi.org/10.1542/peds.2008-3369
Nunez JL, McCarthy MM. Sex differences and hormonal effects in a model of preterm infant brain injury. Ann N Y Acad Sci. 2003;1008:281-4. https://doi.org/10.1196/annals.1301.032
Schauwecker PE, Wood RI, Lorenzana A. Neuroprotection against excitotoxic brain injury in mice after ovarian steroid depletion. Brain Res. 2009;1265:37-46. https://doi.org/10.1016/j.brainres.2009.02.023
Roberts D, Brown J, Medley N, Dalziel SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2017;3:CD004454. https://doi.org/10.1002/14651858.CD004454.pub3
Vinagre LEF, Marba STM. Uso antenatal do corticosteroide e hemorragia peri-intraventricular. Rev Paul Pediatr. 2010;28(3):346-52. https://doi.org/10.1590/S0103-05822010000300014
Heep A, Behrendt D, Nitsch P, Fimmers R, Bartmann P, Dembinski J. Increased serum levels of interleukin 6 are associated with severe intraventricular haemorrhage in extremely premature infants. Arch Dis Child Fetal Neonatal Ed. 2003;88(6):F501-4. https://doi.org/10.1136/fn.88.6.F501
Hansen A, Leviton A. Labor and delivery characteristics and risks of cranial ultrasonographic abnormalities among very-low-birth-weight infants. The Developmental Epidemiology Network Investigators. Am J Obstet Gynecol. 1999;181(4):997-1006. https://doi.org/10.1016/S0002-9378(99)70339-X
Linder N, Haskin O, Levit O, Klinger G, Prince T, Naor N, Turner P, Karmazyn B, Sirota L. Risk factors for intraventricular hemorrhage in very low birth weight premature infants: a retrospective case-control study. Pediatrics. 2003;111(5 Pt 1):e590-5. https://doi.org/10.1542/peds.111.5.e590
Sauer CW, Kong JY, Vaucher YE, Finer N, Proudfoot JA, Boutin MA, Leone TA. Intubation Attempts Increase the Risk for Severe Intraventricular Hemorrhage in Preterm Infants-A Retrospective Cohort Study. J Pediatr. 2016;177:108-13. https://doi.org/10.1016/j.jpeds.2016.06.051
Lee JY, Kim HS, Jung E, Kim ES, Shim GH, Lee HJ, Lee JA, Choi CW, Kim EK, Kim BI, Choi JH. Risk factors for periventricular-intraventricular hemorrhage in premature infants. J Korean Med Sci. 2010;25(3):418-24. https://doi.org/10.3346/jkms.2010.25.3.418
Ment LR, Stewart WB, Duncan CC, Lambrecht R. Beagle puppy model of intraventricular hemorrhage. J Neurosurg. 1982;57(2):219-23. https://doi.org/10.3171/jns.1982.57.2.0219
Klebermass-Schrehof K, Czaba C, Olischar M, Fuiko R, Waldhoer T, Rona Z, Pollak A, Weninger M. Impact of low-grade intraventricular hemorrhage on long-term neurodevelopmental outcome in preterm infants. Childs Nerv Syst. 2012;28(12):2085-92. https://doi.org/10.1007/s00381-012-1897-3
Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, Cioni G, Damiano D, Darrah J, Eliasson AC, de Vries LS, Einspieler C, Fahey M, Fehlings D, Ferriero DM, Fetters L, Fiori S, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Kakooza-Mwesige A, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Maitre N, McIntyre S, Noritz G, Pennington L, Romeo DM, Shepherd R, Spittle AJ, Thornton M, Valentine J, Walker K, White R, Badawi N. Early, accurate diagnosis and early intervention in cerebral palsy: Advances in diagnosis and treatment. JAMA Pediatr. 2017;171(9):897-907. https://doi.org/10.1001/jamapediatrics.2017.1689
Hinojosa-Rodríguez M, Harmony T, Carrillo-Prado C, Van Horn JD, Irimia A, Torgerson C, Jacokes Z. Clinical neuroimaging in the preterm infant: Diagnosis and prognosis. NeuroImage Clin. 2017;16:355-68. https://doi.org/10.1016/j.nicl.2017.08.015
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