Reader variability in use of diagnostic terms to describe WM lesions seen on HUS: the ELGAN study
Sjirk Westra, Ira Adler, Daniel Batton, Bradford Betz, Steven Bezinque, Sara Durfee, Kirsten Ecklund, Kate Feinstein, Lynn Fordham, Joseph Junewick, Robert Lorenzo, Roy McCauley, Cindy Miller, Joanna Seibert, Karl Kuban, Elizabeth Allred, Alan Leviton
J Clin Ultrasound. 2010;38:409-19
Experienced sonologists differ considerably in their tendency to apply diagnostic labels for white matter lesions. This is due to lack of universally agreed-upon definitions.
Antenatal antecedents of a small head circumference at age 24-months post-term equivalent in a sample of infants born before the 28th post-menstrual week
Alan Leviton, Karl Kuban, Elizabeth N Allred, Jonathan L Hecht, Andrew Onderdonk, T Michael O'Shea, Thomas McElrath, Nigel Paneth, ELGAN Study Investigators
Early Hum Dev. 2010;86:515-21
Risk of MC decreased monotonically with increasing GA. After adjusting, the risk of MC at 2 years included MC at birth [odds ratio: 8.8 ((95% confidence interval: 3.7, 21)], alpha hemolytic Streptococci from placenta [2.9 (1.2, 6.9)], males [2.8 (1.6, 4.9)], and the child’s mother un married [2.5 (1.5, 4.3)].
Factors associated with small head circumference at birth among infants born before the 28th week
Thomas F McElrath, Elizabeth N Allred, Karl Kuban, Jonathan L Hecht, Andrew Onderdonk, T Michael O'Shea, Nigel Paneth, Alan Leviton, ELGAN Study Investigators
Am J Obstet Gynecol. 2010;203:138.e1-8
Almost 10% of newborns (n = 138), rather than the expected 2.2%, had MC. In MV models, MC was associated with nonwhite race, severe IUGR, preeclampsia, placental infarction, and being female.
Mechanisms of injury to white matter adjacent to a large intraventricular hemorrhage in the preterm brain
Ira Adler, Dan Batton, Bradford Betz, Steven Bezinque, Kirsten Ecklund, Joseph Junewick, Roy McCauley, Cindy Miller, Joanna Seibert, Barbara Specter, Sjirk Westra, Alan Leviton
J Clin Ultrasound 2010;38:254-258.
Support was found for possibility that ventricular wall does not function as an efficient barrier, allowing ventricular contents to affect WM where it causes damage. PVHI may not be only or most frequent mechanism of WM damage adjacent to a large IVH.
SNAP-II and SNAPPE-II and the risk of structural and functional brain disorders in ELGANs
Olaf Dammann, Mary Naples, Francis Bednarek, Bhavesh Shah, Karl C K Kuban, T Michael O'Shea, Nigel Paneth, Elizabeth N Allred, Alan Leviton, ELGAN Study Investigators
The ELGAN study. Neonatology 2010;97:71-82.
After adjustment for GA, high SNAP-II and SNAPPE-II scores predicted IVH, mod/sev VMeg and EL lesions in cerebral WM. Only 2 highest decile for GA and a Z score >1, predicted EL lesions. Neither SNAP-II nor SNAPPE-II predicted CP. MDI and PDI scores <55 were predicted by both high SNAP-II and SNAPPE-II High SNAP-II and SNAPPE-II inconsistently predicted positive screen for ASD and small HC at 24 mos.
Microbiologic and histologic characteristics of the extremely preterm infant’s placenta predict white matter damage and later cerebral palsy. the ELGAN study
Alan Leviton, Elizabeth N Allred, Karl C K Kuban, Jonathan L Hecht, Andrew B Onderdonk, T Michael O'shea, Nigel Paneth
Pediatr Res. 2010;67:95-101
Recovery of single microorganism predicts EL, whereas polymicrobial cultures & skin flora predicted VM and EL. DP CP predicted by single or multiple organisms, and skin flora. Histologic inflammation predicted VM and DP CP. Risk of VM, but not DP CP, associated with organism recovery, heightened by presence of histologic inflammation. Organism recovery not needed for placenta inflammation to predict DP CP
Inter-institutional variation in prediction of death by SNAP-II and SNAPPE-II among extremely preterm infants
Olaf Dammann, Bhavesh Shah, Mary Naples, Francis Bednarek, John Zupancic, Elizabeth N Allred, Alan Leviton, ELGAN Study Investigators
Pediatrics. 2009;124:e1001-6
The rate of death before day 28 was 13, whereas overall mortality rate was 18%. SNAP-II, SNAPPE-II, and mortality rates ↓ with increasing GA. Even within GA strata, risk of death ↓ with ↓SNAP-II and SNAPPE-II values. The PPV of most SNAP-II and SNAPPE-II cutoff levels were ~30%, especially in infants with SNAP-II >/=30.
The ELGAN study of the brain and related disorders in extremely low gestational age newborns
T M O'Shea, E N Allred, O Dammann, D Hirtz, K C K Kuban, N Paneth, A Leviton, ELGAN study Investigators
Early Hum Dev. 2009;85:719-25
The following are associated with ultrasongraphically detected WMD, CP, or both: preterm labor-preterm delivery, prelabor PROM, or cervical insufficiency; microorgs in placenta, including human skin microflora; placental inflammation; lower GA; greater neonatal illness severity; severe CLD; neonatal bacteremia; and NEC.
Antenatal Complications and the Risk of Neonatal Cerebral White Matter Damage and Later Cerebral Palsy in Children Born at an Extremely Low GA
Thomas F McElrath, Elizabeth N Allred, Kim A Boggess, Karl Kuban, T Michael O'Shea, Nigel Paneth, Alan Leviton, ELGAN Study Investigators
Am J Epidemiol 2009;170:819-828.
Infants w/ACS had lower risks of VMeg & EL (10% vs. 23%, P < 0.001 & 7% vs. 11%, P = 0.06). Risk of VMeg ↑ w/preterm labor: OR = 2.3, 95% CI: 1.1, 4.9), PROM (OR = 3.6, 95% CI: 1.5, 8.7), and cervical insuff (OR = 2.8, 95% CI: 1.4, 5.5) compared w/ infants delivered for PE. Risk of EL lesion was ↑ w/ preterm labor (OR = 2.7, 95% CI: 1.2, 5.7) and IUGR (OR = 3.3, 95% CI: 1.2, 9.4). Doubling of DP risk w/preterm labor & PROM not sign, nor was doubling of QP and tripling of DP risk ass’ed w/ cervical insuff
Maternal antenatal complications and the risk of neonatal cerebral WMD and later CP in ELGANs
Thomas F McElrath, Elizabeth N Allred, Kim A Boggess, Karl Kuban, T Michael O'Shea, Nigel Paneth, Alan Leviton, ELGAN Study Investigators
Am J Epidemiol. 2009;170:819-28
Mothers that received antenatal steroids tended to have lower risks of VM and EL (10% vs. 23%, P < 0.001 and 7% vs. 11%, P = 0.06). Risk of VM was ↑ for infants delivered because of PL (OR = 2.3, 95% CI: 1.1, 4.9), PPROM (OR = 3.6, 95% CI: 1.5, 8.7), and cervical insufficiency (OR = 2.8, 95% CI: 1.4, 5.5) compared to infants delivered because of PE. Risk of an EL was ↑ for infants with PL (OR = 2.7, 95% CI: 1.2, 5.7) and IUGR (OR = 3.3, 95% CI: 1.2, 9.4).