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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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ID 3348
Moeder ID 3084
Volgorde Boswinkel, V.
Naam BoswinkelV
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2016/BoswinkelV/
Gemaakt op: 2017-02-28 10:58:35
Gemodificeerd op: 2017-02-28 11:09:01
Digitaal ID 58b557d957bb7
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel The CHOPIN study : A multicenter study on Cerebellar Hemorrhage and Outcome in Preterm Infants
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 51
Publicatiejaar 2016
Taal en
Engelse samenvatting 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.
Nederlandse samenvatting Doelstelling: Aantonen van associaties tussen de grootte, het aantal en de locatie van cerebellaire bloedingen (CBH) en de uitkomst van de neurologische ontwikkeling bij prematuren, gediagnostiseerd met geïsoleerde CBH, dan wel CBH in combinatie met supratentoriële hersenschade. Daarnaast zal de associatie tussen perinatale, postnatale en maternale factoren en CBH worden onderzocht.
Methode: Er werd een cohort samengesteld van prematuren ( ≤ 34 weken), geboren tussen 2006 en april 2016, en opgenomen op de NICU van een van de drie participerende centra. Data (perinatale factoren, beeldvorming en follow-up bij 2 jaar) werden retrospectief verzameld. MRI’s en/of schedel echo’s werden her beoordeeld om de grootte, het aantal en de locatie van de CBH te bepalen, waarbij onderscheid is gemaakt in punctate CBH: ≤ 4 mm en major CBH: > 4 mm. Tevens werd de aanwezigheid van supratentoriële schade beoordeeld. De samengestelde score voor de neurologische uitkomst werd gedefinieerd aan de hand van de Bayley Scale of infant Developmental (BSID) test en het neurologisch onderzoek.
Resultaten: Gegevens van 111 prematuren werden geanalyseerd. Van 56 kinderen was de samengestelde score voor de neurologische uitkomst beschikbaar. Zeven van de 14 kinderen (50%) met major CBH en 17 van de 42 kinderen (40%) met punctate CBH hadden een afwijkende samengestelde neurologische score. De lateralisatie van CBH (uni- of bilateraal) en laesies met betrekking tot de vermis waren niet significant geassocieerd met een afwijkende score. HFO ventilatie en supratentoriële schade waren onafhankelijke risicofactoren voor een afwijkende score. Onafhankelijke risicofactoren voor het ontstaan van major CBH waren: zwangerschapsduur (gecorreleerd met geboortegewicht), kunstverlossing (tang of vacuüm), ernstige trombocytopenie en de leeftijd van moeder.
Conclusie: Onze resultaten laten zien dat major CBH geassocieerd is met een ongunstige uitkomst ten opzichte van punctate CBH. Er was geen duidelijke associatie tussen de plaats van de bloeding(en) en de uitkomst. De aantallen zijn echter te klein voor definitieve conclusies.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Boiswinkel, V. (Vivian)
Begeleider(s) opleidingsinstelling Supervisors:; Meijler, Dr. G. neonatologist at Isala Hospital Zwolle and; Steggerda, Dr. S.J. neonatologist at Leiden University Medic; Methodological supervisor:; Brohet, Dr. R.M. department of Innovation & Science Isala Ac
Auteur(s) Boiswinkel, V. (Vivian)


 
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