Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection
Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection
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DOI：
10.1001/jama.292.19.2357
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发表时间：
2004-11-17
影响因子：
120.7
通讯作者：
Higgins, RD
中科院分区：
文献类型：
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作者：
Stoll, BJ;Hansen, NI;Higgins, RD
背景 新生儿感染是接受重症监护的极低出生体重 (ELBW) 婴儿的常见并发症。 目的 确定 ELBW 婴儿的新生儿感染是否与幼儿期不良神经发育和生长后遗症的风险增加相关。 设计、设置和参与者 出生时体重 401 至 1000 g 的婴儿（出生于 1993-2001 年）被纳入参与国家医疗中心的学术医疗中心前瞻性收集的极低出生体重登记。儿童健康与人类发展研究所新生儿研究网络。在校正胎龄 18 至 22 个月的全面随访中评估神经发育和生长结果，并按感染组进行比较。百分之八十的幸存者完成了随访，并对 6093 名婴儿进行了研究。登记数据用于按感染类型对婴儿进行分类：未感染（n=2161）、单纯临床感染（n=1538）、脓毒症（n=1922）、脓毒症和坏死性小肠结肠炎（n=279）或伴有或不伴有脓毒症的脑膜炎（n=193）。 主要指标 认知和神经运动发育、神经系统状态、视力和听力以及生长（体重、身长和身高）结果 大多数 ELBW 幸存者 (65%) 在出生后住院期间至少有 1 次感染。与未感染的婴儿相比，4个感染组的婴儿在随访时出现不良神经发育结果的可能性明显更大，包括脑瘫（显着比值比范围[ORs]，1.4-1.7）、贝利婴儿发育量表II的智力发育指数（ORs，1.3-1.6）和精神运动发育指数（ORs，1.5-2.4）得分较低，以及视力障碍（OR，1.3-2.2）。新生儿期的感染还与头部生长受损有关，头部生长受损是神经发育结果不良的已知预测因素。 结论 这项大型队列研究表明，ELBW 婴儿的新生儿感染与幼儿期神经发育和生长结果不良有关。需要进行更多研究来阐明感染婴儿脑损伤的发病机制，以便探索改善这些结果的新干预措施。
Context Neonatal infections are frequent complications of extremely low-birth-weight (ELBW) infants receiving intensive care.Objective To determine if neonatal infections in ELBW infants are associated with increased risks of adverse neurodevelopmental and growth sequelae in early childhood.Design, Setting, and Participants Infants weighing 401 to 1000 g at birth (born in 1993-2001) were enrolled in a prospectively collected very low-birth-weight registry at academic medical centers participating in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth outcomes were assessed at a comprehensive follow-up visit at 18 to 22 months of corrected gestational age and compared by infection group. Eighty percent of survivors completed the follow-up visit and 6093 infants were studied. Registry data were used to classify infants by type of infection: uninfected (n=2161), clinical infection alone (n=1538), sepsis (n=1922), sepsis and necrotizing enterocolitis (n=279), or meningitis with or without sepsis (n=193).Main Outcome Measures Cognitive and neuromotor development, neurologic status, vision and hearing, and growth (weight, length, and head circumference) were assessed at follow-up.Results The majority of ELBW survivors (65%) had at least 1 infection during their hospitalization after birth. Compared with uninfected infants, those in each of the 4 infection groups were significantly more likely to have adverse neurodevelopmental outcomes at follow-up, including cerebral palsy (range of significant odds ratios [ORs], 1.4-1.7), low Bayley Scales of Infant Development II scores on the mental development index (ORs, 1.3-1.6) and psychomotor development index (ORs, 1.5-2.4), and vision impairment (ORs, 1.3-2.2). Infection in the neonatal period was also associated with impaired head growth, a known predictor of poor neurodevelopmental outcome.Conclusions This large cohort study suggests that neonatal infections among ELBW infants are associated with poor neurodevelopmental and growth outcomes in early childhood. Additional studies are needed to elucidate the pathogenesis of brain injury in infants with infection so that novel interventions to improve these outcomes can be explored.