Predictors of Severe Neurologic Injury on Ultrasound Scan of the Head and Risk Factor-based Screening for Infants Born Preterm

Canadian Neonatal Network Investigators

doi:10.1016/j.jpeds.2019.06.065

Predictors of Severe Neurologic Injury on Ultrasound Scan of the Head and Risk Factor-based Screening for Infants Born Preterm

Canadian Neonatal Network Investigators

Medicine

Résultat de recherche: Article › examen par les pairs

16 Citations (Scopus)

Résumé

Objective: 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. Study design: 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. Results: 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). Conclusions: 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.

Langue d'origine	English
Pages (de-à)	27-33.e3
Journal	Journal of Pediatrics
Volume	214
DOI	https://doi.org/10.1016/j.jpeds.2019.06.065
Statut de publication	Published - nov. 2019

Note bibliographique

Funding Information:
Organizational support for the Canadian Neonatal Network was provided by the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, ON, Canada. MiCare is supported by a Canadian Institutes of Health Research (CIHR) Team Grant (CTP 87518), the Ontario Ministry of Health, and support from participating hospitals. P.S. holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the CIHR (APR-126340). The authors declare no conflicts of interest.We thank all site investigators and abstractors of the Canadian Neonatal Network (CNN). We also thank the staff at the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital, Toronto, ON, for organizational support of CNN. In addition, we thank Sarah Hutchinson, PhD, from MiCare for editorial assistance in the preparation of this manuscript. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health, and support from participating hospitals.

Funding Information:
We thank all site investigators and abstractors of the Canadian Neonatal Network (CNN). We also thank the staff at the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital, Toronto, ON, for organizational support of CNN . In addition, we thank Sarah Hutchinson, PhD, from MiCare for editorial assistance in the preparation of this manuscript. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health , and support from participating hospitals.

Publisher Copyright:
© 2019 Elsevier Inc.

ASJC Scopus Subject Areas

Pediatrics, Perinatology, and Child Health

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10.1016/j.jpeds.2019.06.065

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@article{626511b5d4ed4974a98b05a2e0b7f0c5,

title = "Predictors of Severe Neurologic Injury on Ultrasound Scan of the Head and Risk Factor-based Screening for Infants Born Preterm",

abstract = "Objective: 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. Study design: 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. Results: 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). Conclusions: 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.",

author = "{Canadian Neonatal Network Investigators} and Marc Beltempo and Pia Wintermark and Brigitte Lemyre and Wissam Shalish and Andrea Martel-Bucci and Michael Narvey and Ng, {Eugene H.} and Mireille Guillot and Shah, {Prakesh S.} and Jaideep Kanungo and Joseph Ting and Zenon Cieslak and Rebecca Sherlock and Wendy Yee and Jennifer Toye and Carlos Fajardo and Zarin Kalapesi and Koravangattu Sankaran and Sibasis Daspal and Mary Seshia and Ruben Alvaro and Amit Mukerji and {Da Silva}, Orlando and Chuks Nwaesei and Lee, {Kyong Soon} and Michael Dunn and Kimberly Dow and Ermelinda Pelausa and Keith Barrington and Anie Lapoint and Christine Drolet and Bruno Piedboeuf and Martine Claveau and Valerie Bertelle and Edith Masse and Roderick Canning and Hala Makary and Cecil Ojah and Luis Monterrosa and Julie Emberley and Jehier Afifi and Andrzej Kajetanowicz and Lee, {Shoo K.}",

note = "Funding Information: Organizational support for the Canadian Neonatal Network was provided by the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, ON, Canada. MiCare is supported by a Canadian Institutes of Health Research (CIHR) Team Grant (CTP 87518), the Ontario Ministry of Health, and support from participating hospitals. P.S. holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the CIHR (APR-126340). The authors declare no conflicts of interest.We thank all site investigators and abstractors of the Canadian Neonatal Network (CNN). We also thank the staff at the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital, Toronto, ON, for organizational support of CNN. In addition, we thank Sarah Hutchinson, PhD, from MiCare for editorial assistance in the preparation of this manuscript. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health, and support from participating hospitals. Funding Information: We thank all site investigators and abstractors of the Canadian Neonatal Network (CNN). We also thank the staff at the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital, Toronto, ON, for organizational support of CNN . In addition, we thank Sarah Hutchinson, PhD, from MiCare for editorial assistance in the preparation of this manuscript. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health , and support from participating hospitals. Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",

year = "2019",

month = nov,

doi = "10.1016/j.jpeds.2019.06.065",

language = "English",

volume = "214",

pages = "27--33.e3",

journal = "Journal of Pediatrics",

issn = "0022-3476",

publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Predictors of Severe Neurologic Injury on Ultrasound Scan of the Head and Risk Factor-based Screening for Infants Born Preterm

AU - Canadian Neonatal Network Investigators

AU - Beltempo, Marc

AU - Wintermark, Pia

AU - Lemyre, Brigitte

AU - Shalish, Wissam

AU - Martel-Bucci, Andrea

AU - Narvey, Michael

AU - Ng, Eugene H.

AU - Guillot, Mireille

AU - Shah, Prakesh S.

AU - Kanungo, Jaideep

AU - Ting, Joseph

AU - Cieslak, Zenon

AU - Sherlock, Rebecca

AU - Yee, Wendy

AU - Toye, Jennifer

AU - Fajardo, Carlos

AU - Kalapesi, Zarin

AU - Sankaran, Koravangattu

AU - Daspal, Sibasis

AU - Seshia, Mary

AU - Alvaro, Ruben

AU - Mukerji, Amit

AU - Da Silva, Orlando

AU - Nwaesei, Chuks

AU - Lee, Kyong Soon

AU - Dunn, Michael

AU - Dow, Kimberly

AU - Pelausa, Ermelinda

AU - Barrington, Keith

AU - Lapoint, Anie

AU - Drolet, Christine

AU - Piedboeuf, Bruno

AU - Claveau, Martine

AU - Bertelle, Valerie

AU - Masse, Edith

AU - Canning, Roderick

AU - Makary, Hala

AU - Ojah, Cecil

AU - Monterrosa, Luis

AU - Emberley, Julie

AU - Afifi, Jehier

AU - Kajetanowicz, Andrzej

AU - Lee, Shoo K.

N1 - Funding Information: Organizational support for the Canadian Neonatal Network was provided by the Maternal-Infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, ON, Canada. MiCare is supported by a Canadian Institutes of Health Research (CIHR) Team Grant (CTP 87518), the Ontario Ministry of Health, and support from participating hospitals. P.S. holds an Applied Research Chair in Reproductive and Child Health Services and Policy Research awarded by the CIHR (APR-126340). The authors declare no conflicts of interest.We thank all site investigators and abstractors of the Canadian Neonatal Network (CNN). We also thank the staff at the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital, Toronto, ON, for organizational support of CNN. In addition, we thank Sarah Hutchinson, PhD, from MiCare for editorial assistance in the preparation of this manuscript. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health, and support from participating hospitals. Funding Information: We thank all site investigators and abstractors of the Canadian Neonatal Network (CNN). We also thank the staff at the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital, Toronto, ON, for organizational support of CNN . In addition, we thank Sarah Hutchinson, PhD, from MiCare for editorial assistance in the preparation of this manuscript. MiCare is supported by a team grant from the Canadian Institutes of Health Research (CTP 87518), the Ontario Ministry of Health , and support from participating hospitals. Publisher Copyright: © 2019 Elsevier Inc.

PY - 2019/11

Y1 - 2019/11

N2 - Objective: 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. Study design: 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. Results: 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). Conclusions: 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.

AB - Objective: 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. Study design: 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. Results: 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). Conclusions: 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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DO - 10.1016/j.jpeds.2019.06.065

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SN - 0022-3476

VL - 214

SP - 27-33.e3

JO - Journal of Pediatrics

JF - Journal of Pediatrics

ER -

Predictors of Severe Neurologic Injury on Ultrasound Scan of the Head and Risk Factor-based Screening for Infants Born Preterm

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