Antenatal, Perinatal and Neonatal Factors Associated with Periventricular White Matter Injury in Very Preterm Infants
Notice bibliographique
Résumé
Abstract BACKGROUND: Although survival outcome in preterm infants has reached nearly 90%, long-term motor and cognitive disability and cerebral palsy in survivors remain an important concern. Periventricular white matter injury (WMI) is the major form of brain injury underlying these neurological morbidities. Cystic periventricular leukomalacia (cPVL) and porencephaly contribute significantly to poor long-term neurodevelopmen-tal outcomes. Currently, there is no definitive therapy available to treat cPVL or porencephaly. The management mainly lies in identification of associated risk factors and their prevention. Most studies on risk factors of cPVL are limited in their retrospective case-control design and sample size, and have an inherent selection bias with the use of hospital-based data. OBJECTIVES: To identify risk factors for cPVL and porencephaly in a population-based cohort of very preterm infants. DESIGN/METHODS: A retrospective population-based cohort study was conducted at the at the IWK Health Centre, Halifax, Nova Scotia, using data derived from the provincial Perinatal Follow-Up Program (PFUP) database. The PFUP database contains patient data for all pre-term infants born at a gestational age (GA) of <31 weeks in Nova Scotia since 1993. Infants born at 22 to 30 weeks from 1993 to 2013 (21 years) were included in the study. Infants with severe congenital malformations or chromosomal anomalies or who died in the first 6 weeks of life were excluded. Information on potential risk factors (divided into 3 groups: antenatal, perinatal and neonatal) as well as the presence or absence of cPVL and porencephaly diagnosed by cranial ultrasound at 6 weeks of age were extracted. Variables with a P value of < 0.20 in the univariate analysis were entered in the multivariate model using a backwards selection procedure. RESULTS: Of 1184 infants found eligible for the study, 87 (7.4%) had cPVL or porencephaly. Mean GA and birth weight were 27.9 weeks and 1133 g, respectively. The gestational age-adjusted prevalence of cPVL or porencephaly did not decrease over time (p=0.07). In multivariable logistic regression analysis, chorioamniotis (OR 2.2, 95% CI 1.1-4.3), antenatal steroids (OR 0.33, 95% CI 0.18-0.61), admission hypothermia (OR 1.8, 95% CI 1.1-2.9), ventilator support (OR 4.8, 95% CI 1.4-16.9), and non-coagulase negative staphylococcal (OR 2.4, 95% CI 1.2-4.9) and fungal (OR 5.2, 95% CI 1.4-18.6) infections were independently associated with cPVL or porencephaly in the final model. CONCLUSION: This population-based cohort study has identified a number of clinically relevant factors associated with cPVL or porenceph-aly in very preterm infants. The findings have important implications in the delivery of perinatal and neonatal care to reduce the incidence of WMI and consequent, neurological morbidity.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».