The etiology and outcome of cerebral ventriculomegaly at term in very low birth weight preterm infants

Background. Despite improvements in survival data, the incidence of neurode velopmental handicaps in preterm infants remains high. To prevent these han dicaps, one must understand the pathophysiology behind them. For preterm in fants, cerebral ventriculomegaly (VM) may be associated with adverse neurod evelopmental outcome. We hypothesized that although the causes of VM are mu ltiple, the incidence of handicap at 4.5 years of age in preterm infants wi th this ultrasonographic finding at term would be high. Methods. To test this hypothesis, we provided neurodevelopmental follow-up for all 440 very low birth weight survivors of the Multicenter Randomized I ndomethacin Intraventricular Hemorrhage (IVH) Prevention Trial. A total of 384 children (87%) were evaluated at 54 months' corrected age (CA), and 257 subjects were living in English-speaking, monolingual households and axe i ncluded in the following data analysis. Results. Moderate to severe low pressure VM at term was documented in 11 (4 %) of the English-speaking, monolingual survivors. High grade IVH and bronc hopulmonary dysplasia (BPD) were both risk factors for the development of V M. Of 11 (45%) children with VM, 5 suffered grades 3 to 4 IVH, compared wit h 2/246 (1%) children without VM who experienced grades 3 to 4 IVH. Similar ly, 9/11 (82%) children with VM had BPD, compared with 120/246 (49%) childr en without VM who had BPD. Logistic regression analysis was performed using birth weight, gestational age, gender, Apgar score at 5 minutes, BPD, seps is, moderate to severe VM, periventricular leukomalacia, grade of IVH, and maternal education to predict IQ <70. Although maternal education was an im portant and independent predictor of adverse cognitive outcome, in this ser ies of very low birth weight prematurely born children, VM was the most imp ortant predictor of IQ <70 (OR: 19.0; 95% CI: 4.5, 80.6). Of children with VM, 6/11 (55%) had an IQ <70, compared with 31/246 (13%) of children withou t VM. Children with VM had significantly lower verbal and performance score s compared with children without VM. Conclusions. These data suggest that, for preterm neonates, VM at term is a consequence of the vulnerability of the developing brain. Furthermore, its presence is an important and independent predictor of adverse cognitive an d motor development at 4.5 years' CA.