Патология центральной нервной системы у детей с ретинопатией недоношенных

Abstract

Purpose. To evaluate neurosonographic symptoms of preterm infants as a risk criterion for the development of retinopathy of prematurity. Material and Methods. 579 premature babies with risk of retinopathy of prematurity (ROP) (weight up to 2000 g, gestational age 34–35 weeks) were prospectively examined. Ophthalmic monitoring, neurosonographic examination was carried out. The data were statistically processed, the classical Pearson χ² criterion was calculated. Differences were considered significant at p<0.05. Results. ROP developed in 172 cases (29.7%), 57 of them (33%) had a severe type of the disease (ROP type I). In 83 children neurosonographic symptoms of the head of the caudate nucleus ischemia were revealed. Intraventricular hemorrhage of the third stage was formed in 106 children (18.3%); periventricular leukomalacia was detected in 103 cases (17.7%). The incidence of structural hypoxic lesions of the central nervous system was higher in children with ROP. Severe form of ROP, which required surgical intervention, in 54.3% of cases developed in patient with intraventricular hemorrhages of the 3rd stage and in 50.8% of cases in patients with periventricular leukomalacia. There was a significant difference in the incidence of intraventricular hemorrhages of the 3rd stage (df=1; χ²=41.58, p<0.0001) and periventricular leukomalacia (df=1; χ²=41.49, p<0.0001) in children with ROP and without it. There was a significant difference in the incidence of intraventricular hemorrhages of the 3rd stage (df=1; χ² =51.09; p<0.0001) and periventricular leukomalacia (df=1; χ² =25.31; p<0.0001) in children with ROP I and II types. Significant differences in the prevalnece of neurosonographic signs of head ischemia of the caudate nucleus in the first month of life in the group with ROP and the group without ROP were revealed (df=1; χ² =84.14; p<0.0001). Ischemia of caudate nucleus heads was more often detected in children with severe ROP than in children with ROP with spontaneous regression (df=1; χ² =7.79; p=0.053). Specificity (77.4%), accuracy (76.7%), predictive value of the positive result (34.9%) of the diagnostic criterion «Ischemia of caudate nucleus» is higher than similar indices for intraventricular hemorrhage of the third stage and periventricular leukomalacia, p<0.001. The sensitivity of intraventricular hemorrhage of the third stage as a diagnostic criterion differs insignificantly (p=0.04). Conclusion. Neurosonographic symptoms are an early prognostic criterion for the development and severe course of retinopathy of prematurity. Key words: premature infants; retinopathy of prematurity; ophthalmological monitoring; neurosonography; intraventricular hemorrhage; periventricular leukomalacia; ischemia of the head of the caudate nucleus