Early developmental outcomes after newborn encephalopathy
Early developmental outcomes after newborn encephalopathy
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DOI：
10.1542/peds.109.1.26
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发表时间：
2002-01-01
期刊：
影响因子：
8
通讯作者：
Stanley, FJ
中科院分区：
文献类型：
--
作者：
Dixon, G;Badawi, N;Stanley, FJ
Objective.本研究的目的是确定有新生儿脑病病史的儿童的早期发育状况。对1993年6月至1996年12月在西澳大利亚州出生的儿童进行了一项以人群为基础的病例对照研究。该研究包括276名患有中度或重度新生儿脑病的足月儿（大于或等于37周妊娠）和564名不匹配的足月对照受试者。Griffiths精神发育量表用于确定发育状态和一般商数（GQ）评分。结果测量Griffiths发育分量表、GQ、脑瘫诊断和死亡率。34例患者和1例对照受试者在达到评估前死亡。在1994年6月至1999年12月期间，对195例（81%）合格患者和445例（79%）合格对照受试者进行了评估。在GQ和所有发育分量表中，患者和对照组之间存在统计学显著差异。总的来说，39%的患者结局不佳，定义为死亡、脑瘫或明显程度的发育迟缓，而对照组为2.7%。此外，62%的重度脑病患者预后不良，而中度脑病患者预后不良的比例为25%。有癫痫发作史的患者发生脑瘫的可能性是没有癫痫发作史的患者的3倍。总的来说，28例（10.1%）患者患有脑瘫。这些数据提供了关于生存和严重残疾的重要预后信息，并表明新生儿脑病使儿童在第二年面临发育迟缓的重大风险。这些研究结果还表明，需要进行全面的临床和教育评估，以便在这些婴儿接近入学时提供适当的教育。
Objective. The aim of this study was to ascertain the early developmental status of children who have a history of newborn encephalopathy.Methods. A longitudinal follow-up was conducted of a population-based, case-control study of children born in Western Australia between June 1993 and December 1996. The study included 276 term children (greater than or equal to 37 weeks' gestation) with moderate or severe newborn encephalopathy and 564 unmatched term control subjects. The Griffiths Mental Development Scales was used to ascertain developmental status and a General Quotient (GQ) score. Outcome measures were the Griffiths developmental subscales, GQ, diagnosis of cerebral palsy, and mortality.Results. Thirty-four patients and 1 control subject died before reaching assessment. Between June 1994 and December 1999, 195 (81%) eligible patients and 445 (79%) eligible control subjects were assessed. Statistically significant differences were found between patients and control subjects for GQ and all developmental subscales. Overall, 39% of patients had a poor outcome as defined by death, cerebral palsy, or a significant degree of developmental delay, compared with 2.7% of control subjects. Furthermore, 62% of those with severe encephalopathy had a poor outcome compared with 25% of those with moderate encephalopathy. Patients with a history of seizures were 3 times more likely to develop cerebral palsy than patients without. Overall, 28 (10.1%) of patients have cerebral palsy.Conclusions. These data provide important prognostic information regarding survival and serious disability and indicate that newborn encephalopathy places children at significant risk of developmental delay by their second year. These findings also suggest that comprehensive clinical and educational assessments are required to enable appropriate educational provisions as these infants approach school entry.