Predicting Neurologic Outcomes

Predicting Neurologic Outcomes

Broitman E, Ambalavanan N, Higgins RD. et al Clinical data predict neurodevelopmental outcome better than head ultrasound in extremely low birth weight infants. J Pediatr 2007;151:500-5. [Full Text] | [PDF ]

Objective. To determine the relative contribution of clinical data versus head ultrasound scanning (HUS) in predicting neurodevelopmental impairment (NDI) in extremely low birth weight infants.

Study Design: A total of 2103 extremely low birth weight infants (<1000 g) who underwent HUS within the first 28 days, a repeat one around 36 weeks' postmenstrual age, and neurodevelopmental assessment at 18 to 22 months corrected age were selected. Multivariate logistic regression models were developed with clinical or HUS variables. The primary outcome was the predictive abilities of the HUS performed before 28 days after birth and closer to 36 weeks postmenstrual age, either alone or in combination with "Early" and "Late" clinical variables.

Results: Models with clinical variables alone predicted NDI better than models with only HUS variables at both 28 days and 36 weeks (both P < .001), and the addition of the HUS data did not improve prediction. NDI was absent in 30% and 28% of the infants with grade IV intracranial hemorrhage or periventricular leukomalacia, respectively, but was present in 39% of the infants with a normal HUS result.

Conclusions: Clinical models were better than HUS models in predicting neurodevelopment.

Comments. In many occasions, decisions to withdraw or withhold life-saving support from premature infants are frequently based on head ultrasound findings. This study shows that HUS scans do not reliably predict neurodevelopmental impairment in survivors. Moreover the study shows that there is a high prevalence of neurodevelopmental impairment in infants with normal HUS scans or minor grades of intracranial hemorrhage, and the frequent absence of severe neurodevelopmental impairment despite grade IV intracranial hemorrhage or periventricular leukomalacia indicate that the association between HUS findings and neurodevelopmental outcome is not as strong as previously believed. The authors attributed this to the possibility of interobserver variability in interpreting the HUS. Finally this study helps in a way that cranial ultrasound can not be taken alone but as an additional prognostic tool with the multiple clinical variables. SAA.

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