Multiple Postnatal Infections in Newborns Born Preterm Predict Delayed Maturation of Motor Pathways at Term-Equivalent Age with Poorer Motor Outcomes at 3 Years
Multiple Postnatal Infections in Newborns Born Preterm Predict Delayed Maturation of Motor Pathways at Term-Equivalent Age with Poorer Motor Outcomes at 3 Years
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DOI：
10.1016/j.jpeds.2017.12.041
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发表时间：
2018-05-01
影响因子：
5.1
通讯作者：
Miller, Steven P.
中科院分区：
文献类型：
--
作者：
Glass, Torin J. A.;Chau, Vann;Miller, Steven P.
目的评价出生后感染的数量是否与校正年龄36个月时异常白色成熟和较差的运动神经发育结果相关。在2006年至2013年期间招募了32周胎龄的儿童，在生命早期和足月时进行了大脑磁共振成像。出生后感染定义为出生后>= 72小时的任何临床感染或阳性培养。白色物质成熟度通过磁共振波谱成像、磁共振扩散张量成像和基于束的空间统计学进行评估。在校正年龄为35个月（IQR 34-37个月）时，使用Bayley婴幼儿发育量表-III综合评分和Peabody发育运动量表评估了175名（82%的存活婴儿）婴儿的神经发育结局。结果219例早产儿（中位胎龄27.9周）中，109例（50%）无产后感染，83例（38%）有12次感染，27例（12%）有≥ 3次感染。出生后感染的婴儿有更多的小脑出血。感染≥ 3次的婴儿在白色物质和基底节区的N-乙酰天冬氨酸/胆碱较低，内囊后肢的各向异性分数较低，胼胝体、视放射、和内囊后肢的空间统计学分析以及较差的Bayley婴幼儿发育量表-III（P = 0.02）和皮博迪运动发育量表。第二版。结论早产新生儿中，出生后感染≥ 3次预示着儿童早期运动通路发育受损和运动结果较差。
Objectives To evaluate whether the number of postnatal infections is associated with abnormal white matter maturation and poorer motor neurodevelopmental outcomes at 36 months of corrected age.Study design A prospective longitudinal cohort study was undertaken of 219 newborns born preterm at 24-32 weeks of gestational age recruited between 2006 and 2013 with magnetic resonance imaging of the brain both early in life and at term-equivalent age. Postnatal infection was defined as any clinical infection or positive culture >= 72 hours after birth. White matter maturation was assessed by magnetic resonance spectroscopic imaging, magnetic resonance diffusion tensor imaging, and tract-based spatial statistics. Neurodevelopmental outcomes were assessed in 175 (82% of survivors) infants with Bayley Scales of Infant and Toddler Development-III composite scores and Peabody Developmental Motor Scales at 35 months of corrected age (IQR 34-37 months). Infection groups were compared via the Fisher exact test, Kruskal-Wallis test, and generalized estimating equations.Results Of 219 neonates born preterm (median gestational age 27.9 weeks), 109 (50%) had no postnatal infection, 83 (38%) had 1 or 2 infections, and 27 (12%) had >= 3 infections. Infants with postnatal infections had more cerebellar hemorrhage. Infants with >= 3 infections had lower N-acetylaspartate/choline in the white matter and basal ganglia regions, lower fractional anisotropy in the posterior limb of the internal capsule, and poorer maturation of the corpus callosum, optic radiations, and posterior limb of the internal capsule on tract-based spatial statistics analysis as well as poorer Bayley Scales of Infant and Toddler Development-III (P = .02) and Peabody Developmental Motor Scales. Second Edition. motor scores (P < .01).Conclusions In newborns born preterm, >= 3 postnatal infections predict impaired development of the motor pathways and poorer motor outcomes in early childhood.