Predicting long-term neurodevelopmental outcomes in very preterm neonates by umbilical cord gas parameters.
Predicting long-term neurodevelopmental outcomes in very preterm neonates by umbilical cord gas parameters.
复制标题
DOI：
10.1016/j.ajogmf.2020.100248
复制
发表时间：
2021-01
影响因子：
6.3
通讯作者：
Subramaniam A
中科院分区：
文献类型：
--
作者：
Baalbaki SH;Wood SL;Tita AT;Szychowski JM;Andrews WW;Subramaniam A
出生时酸血症对长期神经发育结果的预测价值仍然知之甚少，特别是在早产儿中。目的探讨早产儿脐动脉酸碱状况与5~8岁主要神经发育障碍的关系。从1996年到2001年，我们对457名年龄在23周到31周之间的儿童进行了二次追踪研究。原始队列新生儿脐动脉血气参数10百分位数：pH和lt；7.1，−8.6mEq/L，二氧化碳分压和二氧化碳分压77毫米汞柱。敏感性分析考虑了对异常脐带气体的其他定义，包括pH值和−12。主要结果是主要的神经发育障碍，包括智商和70，脑性瘫痪，失明，耳聋，平衡异常，认知障碍，肌张力障碍和癫痫障碍。Logistic回归被用来调整种族和照顾者智商，在另一项分析中，调整了胎龄。对261例母婴中的259例进行了评估，平均年龄6.8岁，其中228例有完整的脐带气体数据。酸碱值异常和碱基缺失(定义见上文)的婴儿患综合残疾的可能性是后者的四倍多，智商也是70。在调整了年龄和照顾者智商后，这些增加的几率持续存在，但当考虑到胎龄时，脐带气体参数都没有显著预测复合残疾或智商70的存在。然而，当使用更严格的脐带气标准(pH<；7.0，碱基缺失<；−12)时，碱基缺失<；−12与神经发育障碍和IQ<；70独立相关。当定义更严格时，异常脐带气体，特别是碱基缺陷&−12，与早产儿患长期严重神经发育障碍和智商70的风险增加相关。
The predictive value of acidemia at birth for long-term neurodevelopmental outcomes remains poorly understood, especially in preterm neonates. To assess the relationship between umbilical artery acid-base status and major neurodevelopmental disability at age 5–8 years among children born very preterm. We performed a secondary analysis of a follow-up study of a prospective cohort of 457 children between 23 weeks and 31 weeks 6 days from 1996–2001. Arterial cord gas parameters <10th percentile for the original cohort of 457 neonates: pH < 7.1, base deficit <−8.6 mEq/L, and PCO2 > 77mmHg were considered abnormal. Sensitivity analyses considered alternative definitions of abnormal cord gases including pH < 7.0 or base deficit <−12. The primary outcome was a composite of major neurodevelopmental disability, including IQ < 70, cerebral palsy, blindness, deafness, abnormal balance, impaired cognition, dystonia, and seizure disorder. Logistic regression was used to adjust for race and caregiver IQ and, in an additional analysis, for gestational age. 259 of 261 maternal-infant dyads were evaluated at a mean child age of 6.8 years, of which 228 had complete cord gas data. Infants with abnormal pH and base deficit (defined above) were over four times more likely to have the composite disability, as well as IQ < 70. These increased odds persisted after adjustments for age and caregiver IQ, but when considering gestational age as well, none of the cord gas parameters significantly predicted presence of the composite disability or IQ <70. However, when using stricter cord gas criteria (pH < 7.0, base deficit <−12), base deficit < −12, was independently associated with both neurodevelopmental disability and IQ < 70. When defined more strictly, abnormal cord gases, specifically base deficit <−12, are associated with an increased risk of long-term major neurodevelopmental disability and IQ<70 in children born very preterm.
登录
查看更多内容
影响因子：
8
作者：
Wu, Yvonne W.;Xing, Guibo;Gilbert, William M.
通讯作者：
Gilbert, William M.
DOI：
10.1136/fn.71.2.f93
发表时间：
1994-09-01
影响因子：
4.4
作者：
BEEBY, PJ;ELLIOTT, EJ;RIEGER, ID
通讯作者：
RIEGER, ID
影响因子：
9.8
作者：
Andrews, William W.;Cliver, Suzanne P.;Hauth, John C.
通讯作者：
Hauth, John C.
DOI：
10.1136/archdischild-2013-304179
发表时间：
2014-07-01
影响因子：
4.4
作者：
Randolph, David A.;Nolen, Tracy L.;Higgins, Rosemary D.
通讯作者：
Higgins, Rosemary D.
影响因子：
9.8
作者：
Andrews, William W.;Goldenberg, Robert L.;Hauth, John C.
通讯作者：
Hauth, John C.