Neonatal Infection and Later Neurodevelopmental Risk in the Very Preterm Infant
Neonatal Infection and Later Neurodevelopmental Risk in the Very Preterm Infant
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DOI：
10.1016/j.jpeds.2015.11.017
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发表时间：
2016-03-01
影响因子：
5.1
通讯作者：
Woodward, Lianne J.
中科院分区：
文献类型：
--
作者：
Rand, Katherine M.;Austin, Nicola C.;Woodward, Lianne J.
目的记录9岁时确诊和疑似新生儿感染与极早产儿（VPT）运动、认知、教育和心理健康结局之间的关系;研究目的：探讨脑白色异常（WMAs）和结构发育对足月磁共振成像的潜在干预作用。研究设计：在基督城出生的110名VPT婴儿的区域队列，新西兰的研究对象从出生到9岁。确诊感染定义为血液、脑脊液或尿液培养呈阳性，和/或坏死性小肠结肠炎>= 2期。疑似感染定义为使用抗生素≥ 5天，并有临床相关证据。在足月妊娠时，婴儿进行结构磁共振成像。在9岁时，神经运动功能，智商，教育成就和心理healths.Results在住院期间，25%的VPT婴儿已确诊，23%的疑似感染。长期神经发育障碍主要局限于确诊感染的婴儿（相对风险1.4-3.1，与未感染的婴儿相比）。在考虑其他新生儿因素后，这些婴儿发生重度运动障碍（OR 3.3，95% CI 1.3-8）、注意缺陷多动障碍（ADHD）（OR 3.6，95% CI 1.6-8）和智商延迟（OR 2.0，95% CI 1-3.9）的风险增加。脑WMAs有助于确诊感染和运动和智商障碍之间的关联，但不是ADHD（P= 0.005）。结论确诊新生儿感染增加VPT婴儿神经发育障碍的风险。WMA似乎是一个重要的干预因素连接感染和严重的运动和智商障碍。需要进一步分析的神经机制占ADHD的婴儿感染。
Objectives To document associations between confirmed and suspected neonatal infection and motor, cognitive, educational, and mental health outcomes of very preterm (VPT)-born children at 9 years of age; to examine the potential intervening role of cerebral white matter abnormalities (WMAs) and structural development on term magnetic resonance imaging.Study design A regional cohort of 110 infants born VPT in Christchurch, New Zealand were studied from birth to age of 9 years. Confirmed infection was defined as positive blood, cerebrospinal fluid or urine culture, and/or necrotizing enterocolitis >= stage 2. Suspected infection was defined as >= 5 days of antibiotics with evidence of clinical correlates. At term gestational equivalence, infants underwent structural magnetic resonance imaging. At age 9 years, neuromotor function, IQ, educational achievement, and mental health were assessed.Results During hospitalization, 25% of VPT infants had confirmed and 23% had suspected infection. Longer-term neurodevelopmental impairments were largely confined to infants with confirmed infection (relative risk 1.4-3.1, vs uninfected). After accounting for other neonatal factors, these infants were at increased risk of severe motor impairment (OR 3.3, 95% CI 1.3-8), attention deficit hyperactivity disorder (ADHD) (OR 3.6, 95% CI 1.6-8), and IQ delay (OR 2.0, 95% CI 1-3.9). Cerebral WMAs contributed to associations between confirmed infection and motor and IQ impairments but not to ADHD (P=.005).Conclusions Confirmed neonatal infection heightens VPT infants' risk for neurodevelopmental impairment. WMA appears to be an important intervening factor linking infection and severe motor and IQ impairments. Further analysis of the neurologic mechanism accounting for ADHD in infants with infection is needed.