Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants
Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants
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DOI：
10.1542/peds.2005-1368
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发表时间：
2006-04-01
期刊：
影响因子：
8
通讯作者：
Poole, WK
中科院分区：
文献类型：
--
作者：
Ehrenkranz, RA;Dusick, AM;Poole, WK
目标.本研究的目的是评估（1）在极低出生体重儿（ELBW）中，住院生长速度是否能预测校正年龄为18至22个月的神经发育和生长结果;（2）在控制混杂人口统计学和临床变量后，住院生长速度是否有助于这些结果。来自多中心队列研究的出生体重501 - 1000 g的婴儿被分为院内生长速度率的四分位数。Logistic回归模型考虑的变量包括性别、种族、胎龄、小于胎龄儿、母亲的教育程度、重度脑室内出血、脑室周围白质软化、恢复出生体重时的年龄、坏死性小肠结肠炎、迟发性感染、支气管肺发育不良、出生后肺部疾病的类固醇治疗和中心。在600名出院婴儿中，495名（83%）在18至22个月的校正年龄进行了评估。随着体重增加率在第1和第4个四分位数之间增加，从12.0 g/kg/d增加到21.2 g/kg/d，脑瘫、Bayley II精神发育指数（MDI）< 70和精神发育指数（PDI）< 70、异常神经系统检查、神经发育障碍和需要再住院的发生率显著下降。随着头围增长率的增加，也观察到类似的结果。住院生长率与18个月校正年龄时人体测量值低于疾病控制和预防中心2000年生长曲线第10百分位值的可能性相关。逻辑回归分析，控制潜在的人口统计学或临床共同创始人，并调整中心，确定了生长速度和脑瘫的可能性，MDI和PDI评分< 70，和神经发育障碍之间的显着关系。这些分析表明，生长速度在ELBW婴儿的新生儿重症监护病房住院发挥了显着的，可能是独立的，在18至22个月的校正年龄的神经发育和生长结果的影响。
OBJECTIVES. The objectives of this study were to assess whether ( 1) in-hospital growth velocity is predictive of neurodevelopmental and growth outcomes at 18 to 22 months' corrected age among extremely low birth weight (ELBW) infants and ( 2) in-hospital growth velocity contributes to these outcomes after controlling for confounding demographic and clinical variables.METHODS. Infants 501 to 1000 g birth weight from a multicenter cohort study were divided into quartiles of in-hospital growth velocity rates. Variables considered for the logistic-regression models included gender, race, gestational age, small for gestational age, mother's education, severe intraventricular hemorrhage, periventricular leukomalacia, age at regaining birth weight, necrotizing enterocolitis, late-onset infection, bronchopulmonary dysplasia, postnatal steroid therapy for pulmonary disease, and center.RESULTS. Of the 600 discharged infants, 495 (83%) were evaluated at 18 to 22 months' corrected age. As the rate of weight gain increased between quartile 1 and quartile 4, from 12.0 to 21.2 g/kg per day, the incidence of cerebral palsy, Bayley II Mental Developmental Index (MDI) < 70 and Psychomotor Developmental Index (PDI) < 70, abnormal neurologic examination, neurodevelopmental impairment, and need for rehospitalization fell significantly. Similar findings were observed as the rate of head circumference growth increased. The in-hospital rate of growth was associated with the likelihood of anthropometric measurements at 18 months' corrected age below the 10th percentile values of the Centers for Disease Control and Prevention 2000 growth curve. Logistic-regression analyses, controlling for potential demographic or clinical cofounders, and adjusted for center, identified a significant relationship between growth velocity and the likelihood of cerebral palsy, MDI and PDI scores of < 70, and neurodevelopmental impairment.CONCLUSIONS. These analyses suggest that growth velocity during an ELBW infant's NICU hospitalization exerts a significant, and possibly independent, effect on neurodevelopmental and growth outcomes at 18 to 22 months' corrected age.