Antenatal, Perinatal and Neonatal Factors Associated with Periventricular White Matter Injury in Very Preterm Infants
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".