Prognosis: Clinical Scenario
A 27 week gestation infant is born with a birth weight of 900 grams. Cranial ultrasound at one week of age shows a small amount of blood in both ventricles. On repeat ultrasound at one month, the intraventricular hemorrhage is no longer visible, but the left lateral ventricle is dilated beyond the 97th centile for postconceptual age. The infant remains well with no abnormal neurological symptoms or signs. The parents ask you whether their child will have any long term disability. You are uncertain about the implications of unilateral ventriculomegaly that does not require the placement of a ventriculo-peritoneal shunt. .
You formulate the question. "In a premature infant with very low birth weight who is expected to survive, and who has posthemorrhagic ventriculomegaly, what is the risk of future neurological disability?"
A PubMed search is performed: "infant, newborn" (MeSH), "ventriculomegaly" (text word), and "disability" (text word). Three articles are retrieved; one is a perfect match: a recent population-based study of children weighing 500 through 1249 grams at birth Pediatrics 1995; 95(6): 837-44.
Read the article and decide:
- Is the evidence from this randomised trial valid?
- If valid, is this evidence important?
- If valid and important, can you apply this evidence in caring for your patient?