Growth Asymmetry, Head Circumference, and Neurodevelopmental Outcomes in Infants with Single Ventricles
Growth Asymmetry, Head Circumference, and Neurodevelopmental Outcomes in Infants with Single Ventricles
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DOI：
10.1016/j.jpeds.2015.09.041
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发表时间：
2016-01-01
影响因子：
5.1
通讯作者：
Williams, Richard V.
中科院分区：
文献类型：
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作者：
Miller, Thomas A.;Zak, Victor;Williams, Richard V.
目的评价单脑室(SV)婴儿不对称生长的变异性及其与神经发育的关系。研究设计我们分析了前瞻性纳入婴儿单脑室试验的受试者的年龄体重z分数减去年龄头围z分数(HCAZ)、相对头部生长(cm/kg)以及个体生长变量。分析生长指标与14个月时贝利婴儿发育量表(BSID-II)的精神运动发育指数(PDI)和智力发育指数(MDI)得分的相关性。结果在230名参加婴儿单脑室试验的受试者中，168名(73%)获得了完整的生长数据和BSID-II得分。在整个队列中，非对称生长指数在登记时和上腔静脉-肺连接术(SCPC)手术前变化很大。BSID-II评分与这些不对称指数无关。在双变量分析中，较大的SCPC前HCAZ与较高的MDI(r=0.21；P=.006)和较高的PDI(r=0.38；P<；.001)以及从登记到具有较高PDI的SCPC前较高的HCAZ增加(r=0.15；P=0.049)相关。在多变量模型中，SCPC前HCAZ是PDI的独立预测因子(P=0.03)，但不是MDI。结论在SV患儿中，生长不对称与14个月时的神经发育无关，但SCPC前HCAZ与PDI有关。不对称生长在其他高危婴儿中很重要，但对于患有室性心动过速的婴儿来说，不是一种节省大脑的适应。
Objective To assess the variability in asymmetric growth and its association with neurodevelopment in infants with single ventricle (SV).Study design We analyzed weight-for-age z-score minus head circumference-for-age z-score (HCAZ), relative head growth (cm/kg), along with individual growth variables in subjects prospectively enrolled in the Infant Single Ventricle Trial. Associations between growth indices and scores on the Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) of the Bayley Scales of Infant Development-II (BSID-II) at 14 months were assessed.Results Of the 230 subjects enrolled in the Infant Single Ventricle trial, complete growth data and BSID-II scores were available in 168 (73%). Across the cohort, indices of asymmetric growth varied widely at enrollment and before superior cavopulmonary connection (SCPC) surgery. BSID-II scores were not associated with these asymmetry indices. In bivariate analyses, greater pre-SCPC HCAZ correlated with higher MDI (r = 0.21; P = .006) and PDI (r = 0.38; P < .001) and a greater HCAZ increase from enrollment to pre-SCPC with higher PDI (r = 0.15; P = .049). In multivariable modeling, pre-SCPC HCAZ was an independent predictor of PDI (P = .03), but not MDI.Conclusion In infants with SV, growth asymmetry was not associated with neurodevelopment at 14 months, but pre-SCPC HCAZ was associated with PDI. Asymmetric growth, important in other high-risk infants, is not a brain-sparing adaptation in infants with SV.