Early preterm birth: association between in utero exposure to acute inflammation and severe neurodevelopmental disability at 6 years of age
Early preterm birth: association between in utero exposure to acute inflammation and severe neurodevelopmental disability at 6 years of age
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DOI：
10.1016/j.ajog.2007.12.031
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发表时间：
2008-04-01
影响因子：
9.8
通讯作者：
Hauth, John C.
中科院分区：
文献类型：
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作者：
Andrews, William W.;Cliver, Suzanne P.;Hauth, John C.
目的：本研究的目的是确定在子宫内暴露于急性炎症和长期的主要神经发育障碍之间的关联，在6岁的儿童出生前32周pregnancy.Study设计：这是一个后续调查的一个队列的母婴二对之间提供23和< 32周的妊娠。存活的婴儿（以及他们的母亲或照顾者）在5至8岁之间接受了一系列心理和神经发育测试。对有和没有主要神经发育障碍的儿童的妊娠和新生儿数据进行了分析（包括IQ < 70 [n = 41]，脑瘫[CP，n = 11]，和复合严重残疾[n = 52]）。在375例存活儿童的母婴配对中，共有261例（70%）成功招募，并在6.8 +/- 0.7岁时进行了评估。平均分娩胎龄（GA）和出生体重分别为28.8 ± 2.2周和1163 ± 382 g。子宫内暴露于急性炎症的替代指标和直接标志物均与严重不良结局无显著相关性。分娩GA与结局显著相关。Logistic回归分析显示，孕周每增加一周，IQ < 70的风险显著降低（OR 0.75，95%CI 0.6-0.9）。在6岁时，每增加一个孕周（23至32周），智商平均增加1.9分。脑室周围白质软化症与平均智商9.6分的缺陷有关。感知词汇得分在智商< 70的儿童中，主要照顾者的智商（IQ代理）显著低于智商< 70的儿童（87.5 ± 11.5 vs 92.1 ± 11.2，P ± 0.016）。结论：在妊娠23至32周之间出生的儿童中，新生儿并发症、分娩时GA和照顾者IQ，但在子宫内暴露于急性炎症中，与6岁时严重不良神经发育结局的风险增加相关。
OBJECTIVE: The purpose of this study was to determine the association between in utero exposure to acute inflammation and long-term major neurodevelopmental disability at age 6 years among children born prior to 32 weeks' gestation.STUDY DESIGN: This was a follow-up investigation of a cohort of maternal-infant dyads delivered between 23 and < 32 weeks' gestation. Surviving infants (and their mothers or caregivers) underwent a battery of psychological and neurodevelopmental tests between 5 and 8 years of age. Pregnancy and neonatal data were analyzed among children with versus those without major neurodevelopmental disability ( including IQ < 70 [n = 41], cerebral palsy [CP, n = 11], and a composite major disability [n = 52]).RESULTS: A total of 261 (70%) of the 375 maternal-infant dyads with surviving children were successfully recruited and evaluated at 6.8 +/- 0.7 years. Mean delivery gestational age (GA) and birthweight were 28.8 +/- 2.2 weeks and 1163 +/- 382 g, respectively. Neither surrogate indicators for nor direct markers of in utero exposure to acute inflammation were significantly associated with severe adverse outcomes. Delivery GA was significantly associated with outcome. Logistic regression indicated that each increasing gestational week was associated with a significantly decreased risk of an IQ < 70 (OR 0.75, 95% CI 0.6-0.9). An average 1.9 point increase in IQ at 6 years of age was observed per gestational week gained (23 to 32 weeks). Periventricular leukomalacia was associated with a 9.6 point mean deficit in IQ. The perceptive vocabulary scores (IQ proxy) of primary caregivers were significantly lower among children with an IQ < 70 vs < 70 (87.5 +/- 11.5 vs 92.1 +/- 11.2, P +/- .016).CONCLUSION: Among children born between 23 and 32 weeks' gestation, neonatal complications, GA at delivery, and caregiver IQ, but not in utero exposure to acute inflammation, were associated with increased risk of severe adverse neurodevelopmental outcomes at age 6 years.