Early surgery and neurodevelopmental outcomes of children born extremely preterm
Early surgery and neurodevelopmental outcomes of children born extremely preterm
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DOI：
10.1136/archdischild-2017-313161
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发表时间：
2018-05-01
影响因子：
4.4
通讯作者：
Doyle, Lex W.
中科院分区：
文献类型：
--
作者：
Hunt, Rodney W.;Hickey, Leah M.;Doyle, Lex W.
目的(1)比较在首次住院期间接受手术治疗的极早产儿(EP)8岁时的神经发育结果，以及(2)比较1991-2005年不同时期的结果。设计前瞻性观察性队列研究，分三个不同时期(1991-1992、1997和2005)进行。在初次住院期间需要手术治疗的存活的EP儿童在8岁时接受了一般智力(IQ)和神经感觉状态的评估。主要神经感觉障碍包括中/重度脑性瘫痪、智商低于-2 SD(相对于足月对照组)、失明或耳聋。结果总体而言，29%(161/546)的幸存者在新生儿期接受过手术，每个时代的比率相似。8年的随访率很高(91%；499/546)，评估的幸存者中有17%(86/499)有严重的神经感觉障碍。手术组的主要神经感觉障碍发生率(33%；52/158)显著高于未手术组(10%；34/341)(OR 4.28，95%CI 2.61至7.03)。手术组的致残率并没有随着时间的推移而改善。在调整了相关混杂因素后，没有特定的手术操作与残疾风险的增加相关。含义和相关性出生时在首次住院期间接受手术的EP儿童8岁时的主要神经感觉障碍比那些没有接受手术的儿童更高。手术队列中的主要神经感觉障碍的比率并没有随着时间的推移而改善。
Objectives To (1) compare the neurodevelopmental outcomes at 8 years of age of children born extremely preterm (EP) who underwent surgical procedures during the course of their initial hospital admission with those who did not and (2) compare the outcomes across eras, from 1991 to 2005.Design Prospective observational cohort studies conducted over three different eras (1991-1992, 1997 and 2005). Surviving EP children, who required surgical intervention during the primary hospitalisation, were assessed for general intelligence (IQ) and neurosensory status at 8 years of age. Major neurosensory disability comprised any of moderate/severe cerebral palsy, IQ less than -2 SD relative to term controls, blindness or deafness.Results Overall, 29% (161/546) of survivors had surgery during the newborn period, with similar rates in each era. Follow-up rates at 8 years were high (91%; 499/546), and 17% (86/499) of survivors assessed had a major neurosensory disability. Rates of major neurosensory disability were substantially higher in the surgical group (33%; 52/158) compared with those who did not have surgery (10%; 34/341) (OR 4.28, 95% CI 2.61 to 7.03). Rates of disability in the surgical group did not improve over time. After adjustment for relevant confounders, no specific surgical procedure was associated with increased risk of disability.Implications and relevance Major neurosensory disability at 8 years was higher in children born EP who underwent surgery during their initial hospital admission compared with those who did not. The rates of major neurosensory disability in the surgical cohort are not improving over time.