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The CHOPIN study : A multicenter study on Cerebellar Hemorrhage and Outcome in Preterm Infants

(2016) Boiswinkel, V. (Vivian)

Objective: To investigate the association between size, number and location of cerebellar hemorrhage (CBH) and neurodevelopmental outcome in very preterm infants, diagnosed with either isolated CBH or combined CBH and supratentorial brain lesions. Secondly, the aim is to investigate associations between perinatal, postnatal and maternal factors and CBH.
Methods: A cohort of preterm infants (≤ 34 weeks) born between 2006 and April 2016, and admitted to one of the three participating Dutch NICUs, was generated. Data (perinatal factors, neuro-imaging and follow-up at 2 years) were retrospectively collected. MRI and/or cranial ultrasound scans were reassessed to determine the exact size, number and location of CBH and the presence of supratentorial injury. Infants were divided between two groups: punctate CBH (≤ 4 mm) or major CBH (> 4 mm). The composite outcome score for neurodevelopmental outcome was defined by the result of the Bayley Scale of infant Developmental (BSID) test and the neurological examination.
Results: Data of 111 preterm infants were analyzed. Of 56 infants the composite outcome score could be obtained. Seven out of 14 infants (50%) with major CBH and 17 out of 42 (40%) with punctate CBH had an abnormal composite outcome score. Laterality of CBH and vermian lesions were not significant associated with an abnormal composite outcome score. HFO ventilation ventilation and supratentorial injury were independent risk factors for an abnormal composite outcome score. Independent risk factors for the occurrence of major CBH were gestational age (correlated with birth weight), forceps or ventouse delivery, severe thrombocytopenia (with a platelet count < 50) and maternal age.
Conclusion: Our results show that major CBH is associated with an unfavorable outcome when compared to punctate CBH. No evident association between the size and location of CBH and outcome was found. However, the study population was too small to draw firm conclusions.

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