Early Inflammatory Measures and Neurodevelopmental Outcomes in Preterm Infants.
Early Inflammatory Measures and Neurodevelopmental Outcomes in Preterm Infants.
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DOI：
10.1097/nnr.0000000000000448
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发表时间：
2020
期刊：
影响因子：
2.5
通讯作者：
Pickler RH
中科院分区：
文献类型：
--
作者：
Nist MD;Shoben AB;Pickler RH
炎症可能是早产儿长期神经发育的重要预测因子。识别预测预后的特异性炎症生物标志物是一个重要的研究目标。这项分析的目的是确定早期炎症测量与早产儿神经发育之间的联系，并确定基于婴儿性别和种族的炎症和神经发育之间关系的差异。我们对一项随机对照试验的数据进行了二次分析，该试验对月经后年龄小于33周的早产儿进行了护理干预。新生儿重症监护病房护士用临床指示的实验室抽血收集血浆，并通过细胞因子、趋化因子和生长因子的多重检测分析。神经行为由研究护士在新生儿重症监护病房出院时使用早产儿神经行为评估中的运动发育、活力和警觉性/定向集群进行评估。神经发育在6个月矫正年龄时由医院新生儿随访门诊的发育专家使用Bayley婴儿发育量表，第三版进行评估。我们使用线性回归来估计细胞因子水平对神经发育的影响，并允许影响因婴儿性别和种族而异。在62名接受出院神经行为评估的早产儿样本和40名接受6个月神经发育评估的早产儿样本中，我们发现在对总样本的分析中，单时间点炎症测量与神经行为或神经发育之间存在不一致的关联。然而，相互作用的回归显示，多种炎症措施对早期神经行为和神经发育的影响因婴儿性别和种族而异。尽管早期的单时间点炎症测量可能不足以预测所有早产儿的神经发育，但炎症的影响似乎因婴儿性别和种族而异。这些人口因素可能是未来炎症和神经发育研究的重要考虑因素，也是未来干预措施的发展，以优化结果。
Inflammation may be an important predictor of long-term neurodevelopment in preterm infants. The identification of specific inflammatory biomarkers that predict outcomes is an important research goal. The purpose of this analysis was to identify associations between an early measure of inflammation and neurodevelopment in very preterm infants and to identify differences in the relationship between inflammation and neurodevelopment based on infant sex and race. We conducted a secondary analysis of data from a randomized controlled trial of a caregiving intervention for preterm infants born less than 33 weeks post-menstrual age. Plasma was collected with a clinically-indicated lab draw by neonatal intensive care unit nurses and analyzed by multiplex assay for cytokines, chemokines, and growth factors. Neurobehavior was assessed by research nurses at the time of discharge from the neonatal intensive care unit using the motor development and vigor and alertness/orientation clusters from the Neurobehavioral Assessment of the Preterm Infant. Neurodevelopment was assessed at six months corrected age by the developmental specialist in the hospital’s neonatal follow-up clinic using the Bayley Scales of Infant Development, 3rd Edition. We used linear regressions to estimate the effect of cytokine levels on neurodevelopment and allowed the effects to differ by infant sex and race. In a sample of 62 preterm infants with discharge neurobehavioral assessments and a sample of 40 preterm infants with six month neurodevelopmental assessments, we found inconsistent associations between single-timepoint inflammatory measures and neurobehavior or neurodevelopment in analyses of the total sample. However, regressions with interactions revealed effects for multiple inflammatory measures on early neurobehavior and neurodevelopment that differed by infant sex and race. Although early single-timepoint measures of inflammation may be insufficient to predict neurodevelopment for all preterm infants, the effect of inflammation appears to differ by infant sex and race. These demographic factors may be important considerations for future studies of inflammation and neurodevelopment as well was the development of future interventions to optimize outcomes.