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Centre for Evidence-
Based Medicine

Patent Ductus Arteriosus: Risk of disability

Clinical Bottom Line

A premature infant with cranial ultrasound finding of posthemorrhagic ventriculomegaly has a 48% chance of being disabled, if he survives beyond one year of age.

Citation

Aziz K., Vickar D.B., Sauve R.S., et al. Province-Based Study of Neurologic Disability of Children Weighing 500 Through 1249 Grams at Birth in Relation to Neonatal Cerebral Ultrasound Findings. Pediatrics 1995; 95(6): 837-44.

Clinical Question

In a preterm infant who is expected to survive with posthemorrhage ventriculomegaly, what is the risk of future neurological disability?

Search Terms

PubMed search using MeSH term "infant, newborn", and text words "ventriculomegaly" and "disability".

The Study

  • The Study Patients: Provincial cohort of 646 preterm infants with birth weights 500 gm to 1249 gm who survived beyond the first year of age.
  • Prognostic Factor: Cranial ultrasounds performed prior to discharge to detect intraventricular hemorrhage (IVH) or cerebral ventriculomegaly (CV). Follow-up assessments were performed at 2 to 3 years of age, and included physical, sensory and psychological assessment.
  • The Outcome: Disability (which included CP, visual loss, mental retardation, epilepsy, and neurosensory hearing loss).
  • A well-defined sample at uniform stage of illness, follow-up sufficiently long and complete, can't tell if blinded objective outcome criteria, no adjustment for other prognostic factors, no validation in an independent test-set of patients.

The Evidence

Prognostic Factor Outcome Time Measure Confidence Interval Independent?
Isolated free blood or a clot in ventricles (IVH) Percent disabled 2-3 yrs 0% No
CV with any other defect(s) Percent disabled 2-3 yrs 48% (34%, 62%) No
IVH with CV Percent disabled 2-3 yrs 29% (10%, 48%) No

Comments

  1. Uncertain whether outcome assessors were blinded
  2. Despite large cohort, small number of patients in each category

Appraised By

Aaron Chiu
Department of Pediatrics and Child Health
University of Manitoba; 27 January 1999
Email: chiua@cc.umanitoba.ca

Expiry Date

December 31, 2000