Cranial ultrasonography and transfontanellar Doppler in premature neonates (24-32 weeks of gestation): dynamic evolution and association with a severe adverse neurological outcome at hospital discharge in the Aquitaine cohort, 2003-2005.
OBJECTIVE
To correlate the short-term neurological outcome of early cerebral abnormalities using cranial ultrasonography (US) in premature newborns at their hospital discharge.


METHODS
Each newborn born <33 weeks of gestational age (GA) included in a prospective cohort benefited of 3 US: two early in the first week of life (D3 and D8) and one later (Months 1-2) standardized US pulsed Doppler. A US abnormality was ≥one morphologic abnormality (moderate: intra-ventricular hemorrhage (IVH) grades 1-2; severe: IVH 3-4, periventricular leukomalacia, persistent flares). Correlates of having a severe adverse neurological outcome were analyzed using a stepwise backward logistic regression adjusted model with gestational age, early cerebral abnormality at Days 3-8, velocity and with variables with correlation probabilities with p<0.25 in the univariate analysis among occurring co-morbidity events previously defined. Two adjusted logistic regression analyses were conducted including or not velocity data because of missing information.


RESULTS
Among 452 premature included, 11.3% did not have an early US, 74.8% had a normal early US, 13.9% ≥one early morphological US abnormality (10.0% moderate, 3.9% severe). At hospital discharge, 40% were still alive with a normal late US, 33% alive with ≥one late morphological US abnormality (10% moderate, 23% severe), and 10% died. Adjusted correlates of a late US severe abnormality or a neurological related death at hospital discharge were: early US abnormality (aOR: 8.7, 95% CI: 2.3-33.6), GA<29 weeks (aOR: 2.8 95% CI: 1.4-5.4).


CONCLUSIONS
This study shows that early US morphological abnormalities increase significantly when the GA decreases and is highly predictive of the occurrence of a further late US severe abnormality or neurological related death at hospital discharge.
CHU de Bordeaux, Unité de soins intensifs néonatale et pédiatrique, F-33000 Bordeaux, France. olivier.brissaud@chu-bordeaux.fr
Olivier
O
Brissaud
Sabah
S
Boufkhed
Laurence
L
Joly
Christine
C
Germain
Agnès
A
Bouvet-Murcia
Muriel
M
Brun
Jean-François
JF
Chateil
Valériane
V
Leroy
D001921:Brain / Q000002:abnormalities*; D015331:Cohort Studies; D004453:Echoencephalography / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D009422:Nervous System Diseases / Q000000981:diagnostic imaging* / Q000401:mortality*; D010351:Patient Discharge / Q000706:statistics & numerical data; D015995:Prevalence; D016019:Survival Analysis; D015996:Survival Rate; D018608:Ultrasonography, Doppler / Q000706:statistics & numerical data*