Autism and neurodevelopmental disability risks in children with tracheostomies and ventilators.
Autism and neurodevelopmental disability risks in children with tracheostomies and ventilators.
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接受气管切开术和呼吸机的儿童存在自闭症和神经发育障碍风险。
DOI：
10.1002/ppul.26921
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发表时间：
2024
影响因子：
3.1
通讯作者：
Msall,MichaelE
中科院分区：
文献类型：
--
作者：
Sobotka,SarahA;Lynch,Emma;Liao,Chuanhong;Graham,RobertJ;Msall,MichaelE
早产儿和其他危重疾病存活的婴儿出院后（在家）需要持续的有创机械通气（IMV），发育迟缓和残疾的风险很高。对极早产儿（<28周妊娠）的研究表明，智力残疾（ID）的发生率为25%，自闭症谱系障碍（ASD）的发生率为7%。IMV患儿ASD和ID的发生率尚不清楚。本研究的目的是确定神经发育障碍的风险，在一个队列的儿童出院后IMV。设计/MethodsA连续一系列的儿童IMV出院后1个月，6个月，1年进行了评估。由发育和行为儿科医生使用（1）capute量表的临床适应性测试/临床语言和听觉里程碑量表（CAT/CLAMS）;（2）残疾儿童评估量表计算机适应性测试（PEDI‐CAT）;和（3）改良的幼儿自闭症检查表（MCHAT‐R）评估认知、社会和交流领域。注意到使用DSM-V标准的ASD的红旗体征和症状。回顾了纵向试验。专家共识的印象，不断发展的ASD和/或ID determined.Results18名儿童进行了为期1年，在1年，中位年龄（范围）为23（17-42）个月。儿童中44%为男性，33%为非西班牙裔白色，39%为非西班牙裔黑人，28%为西班牙裔。15名（83%）儿童为早产幸存者。中位（范围）发育指标（DQ）：全量表DQ 59（11-86），CAT DQ 66.5（8-96）和CLAMS DQ 49.5（13-100）。12名（67%）儿童高度怀疑ASD和/或发展中的ID。结论/显着性这一队列的儿童在家里IMV表现出更高的风险ASD和ID比以前的早产儿队列。需要更大规模的研究和更长时间的随访。
Background/ObjectiveInfants who survive prematurity and other critical illnesses and require continued invasive mechanical ventilation (IMV) postdischarge (at home) are at high risk of developmental delays and disabilities. Studies of extremely preterm cohorts (<28‐week gestation) demonstrate rates of 25% for intellectual disability (ID) and 7% for autism spectrum disorder (ASD). Rates of ASD and ID in children with IMV are unknown. This study aimed to determine neurodevelopmental disability risk in a cohort of children with postdischarge IMV.Design/MethodsA consecutive series of children with IMV were assessed 1 month, 6 months, and 1 year after discharge. Cognitive, social, and communicative domains were assessed by a Developmental and Behavioral Pediatrician using (1) clinical adaptive test/clinical linguistic and auditory milestone scale (CAT/CLAMS) of the capute scales; (2) pediatric evaluation of disability inventory computer adaptive test (PEDI‐CAT); and (3) modified checklist for autism in toddlers, revised (MCHAT‐R). Red flag signs and symptoms of ASD using DSM‐V criteria were noted. Longitudinal testing was reviewed. Expert consensus impressions of evolving ASD and/or ID were determined.ResultsEighteen children were followed for 1 year; at 1 year, the median age (range) was 23 (17–42) months. Children were 44% male, 33% non‐Hispanic White, 39% non‐Hispanic Black, and 28% Hispanic. Fifteen (83%) children were prematurity survivors. Median (range) developmental quotients (DQs): full‐scale DQ 59 (11–86), CAT DQ 66.5 (8–96), and CLAMS DQ 49.5 (13–100). Twelve (67%) children were highly suspicious for ASD and/or evolving ID.Conclusions/SignificanceThis cohort of children with at‐home IMV demonstrates a higher risk of ASD and ID than prior premature cohorts. Larger investigations with longer follow‐up are needed.