PT  - JOURNAL ARTICLE
AU  - S. Desai
AU  - G. Athalye-Jape
AU  - S. Madhala
AU  - W. Tee
AU  - M. Sharp
AU  - E. Nathan
AU  - D. Shrestha
AU  - S. Patole
TI  - Comparison of Papile versus Laterality-Based Al-Abdi System to Predict Neurodevelopmental Impairment in Extreme Preterm Infants after Severe Germinal Matrix Hemorrhage–Intraventricular Hemorrhage: A Retrospective Comparative Observational Study
AID  - 10.3174/ajnr.A7434
DP  - 2022 Mar 01
TA  - American Journal of Neuroradiology
PG  - 486--492
VI  - 43
IP  - 3
4099  - http://www.ajnr.org/content/43/3/486.short
4100  - http://www.ajnr.org/content/43/3/486.full
SO  - Am. J. Neuroradiol.2022 Mar 01; 43
AB  - BACKGROUND AND PURPOSE: The traditional Papile classification system for severe germinal matrix hemorrhage–intraventricular hemorrhage is limited in objectivity and interrater variability for accurate prediction of neurodevelopmental impairment in extremely preterm infants. Many extremely preterm infants with severe germinal matrix hemorrhage–intraventricular hemorrhage are still offered “redirection of care” in spite of the recent evidence suggesting that many of these infants can have normal outcomes. Therefore, it is important to consider the laterality and extent of brain hemisphere involvement while classifying severe germinal matrix hemorrhage–intraventricular hemorrhage to predict neurodevelopmental impairment. The aim of the present study was to compare the Al-Abdi system with the Papile system for their accuracy in predicting neurodevelopmental impairment in extremely preterm infants with severe germinal matrix hemorrhage–intraventricular hemorrhage.MATERIALS AND METHODS: This is a retrospective study of extremely preterm infants with severe germinal matrix hemorrhage–intraventricular hemorrhage admitted to a tertiary neonatal intensive care unit (2006–2016). Cranial sonograms were independently re-reviewed by 2 radiologists as per the Al-Abdi system. The prognostic statistical indices for both systems to predict neurodevelopmental impairment were calculated.RESULTS: A total of 91 infants with severe germinal matrix hemorrhage–intraventricular hemorrhage survived, and 83 (median gestational age, 26.3 weeks; and median birth weight, 890 g) completed developmental assessment. The receiver operating characteristic areas under the curve to predict neurodevelopmental impairment by the Papile versus Al-Abdi systems were 0.702 versus 0.723, respectively (P = .474). Corresponding Al-Abdi cutoff scores of 19, 20, 21, and 22 demonstrated increased specificity (76.36%–85.45%) and correct classification (69.88%–72.29%) to predict moderate-to-severe neurodevelopmental impairment.CONCLUSIONS: The Al-Abdi system is comparable with the Papile system for predicting neurodevelopmental impairment for extremely preterm infants with severe germinal matrix hemorrhage–intraventricular hemorrhage, with higher Al-Abdi scores being more specific. This finding may prove useful for neonatal health care providers and parents in their decision regarding “continuation of care.” Future multicentric studies are warranted to ascertain the validity of individual Al-Abdi scores.AUCarea under the curveBSIDBayley Scales of Infant and Toddler DevelopmentBWbirth weightCPcerebral palsyEPextremely pretermGAgestational ageGMDSGriffiths Mental Developmental ScaleGMFCSGross Motor Functional Classification SystemGMH–IVHgerminal matrix hemorrhage–intraventricular hemorrhageNDIneurodevelopmental impairmentNICUneonatal intensive care unitPVHIperiventricular hemorrhagic infarctionROCreceiver operating characteristic