Developmental outcome of very low birth weight infants in a developing country.
Developmental outcome of very low birth weight infants in a developing country.
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DOI：
10.1186/1471-2431-12-11
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发表时间：
2012-02-01
期刊：
影响因子：
2.4
通讯作者：
Cooper PA
中科院分区：
文献类型：
--
作者：
Ballot DE;Potterton J;Chirwa T;Hilburn N;Cooper PA
新生儿护理的进步使极早产儿得以存活，但他们有残疾的风险。对这些婴儿进行神经发育随访是对新生儿护理持续评估的重要部分。资源有限的发展中国家的新生儿护理与第一世界国家的情况大不相同。来自发展中国家的随访数据至关重要；不宜从发达国家的医疗单位推断数据。本研究提供了南非约翰内斯堡一群极低出生体重（VLBW）婴儿的随访数据。
研究样本包括2006年6月1日至2007年2月28日期间在夏洛特·马克西克·约翰内斯堡学术医院（CMJAH）新生儿病房出院的所有极低出生体重婴儿。使用贝利婴幼儿发展量表第三版（BSID - III）进行发育评估。进行回归分析以确定与不良结果相关的因素。
178名婴儿出院，26名无法进行随访，其余152名中有9名（5.9%）在评估前死亡；其余143名中有106名（74.1%）接受了BSID - III评估。这106名患者构成了研究样本；平均出生体重为1182克（标准差：197.78），平均胎龄为30.81周（标准差：2.67）。BSID - III在中位年龄16.48个月时进行评估。平均认知分量表得分为88.6（95%置信区间：85.69 - 91.59），9名（8.5%）得分<70；平均语言分量表得分为87.71（95%置信区间：84.85 - 90.56），10名（9.4%）得分<70；平均运动分量表得分为90.05（95%置信区间：87.0 - 93.11），8名（7.6%）得分<70。在每个分量表中，大约三分之一的婴儿被确定为有风险（得分在70到85之间）。4名（3.7%）婴儿被诊断为脑瘫。与不良结果相关的因素包括脑室周围囊性白质软化症（PVL）、出生时复苏、产妇产次、住院时间延长和补充氧气的使用时间。PVL与所有三个分量表的不良结果相关。出生体重和胎龄不能预测神经发育结果。
尽管这群极低出生体重婴儿的神经发育结果在正常范围内，脑瘫发生率较低，但这些结果可能反映了出生体重低于900克的婴儿存活率较低。此外，平均分量表得分较低，三分之一的婴儿被确定为“有风险”，这表明这群婴儿需要随访至入学年龄。
Advances in neonatal care allow survival of extremely premature infants, who are at risk of handicap. Neurodevelopmental follow up of these infants is an essential part of ongoing evaluation of neonatal care. The neonatal care in resource limited developing countries is very different to that in first world settings. Follow up data from developing countries is essential; it is not appropriate to extrapolate data from units in developed countries. This study provides follow up data on a population of very low birth weight (VLBW) infants in Johannesburg, South Africa. The study sample included all VLBW infants born between 01/06/2006 and 28/02/2007 and discharged from the neonatal unit at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Bayley Scales of Infant and Toddler Development Version 111 (BSID) 111 were done to assess development. Regression analysis was done to determine factors associated with poor outcome. 178 infants were discharged, 26 were not available for follow up, 9 of the remaining 152 (5.9%) died before an assessment was done; 106 of the remaining 143 (74.1%) had a BSID 111 assessment. These 106 patients form the study sample; mean birth weight and mean gestational age was 1182 grams (SD: 197.78) and 30.81 weeks (SD: 2.67) respectively. The BSID (111) was done at a median age of 16.48 months. The mean cognitive subscale was 88.6 (95% CI: 85.69 - 91.59), 9 (8.5%) were < 70, mean language subscale was 87.71 (95% CI: 84.85 - 90.56), 10 (9.4%) < 70, and mean motor subscale was 90.05 (95% CI: 87.0 - 93.11), 8 (7.6%) < 70. Approximately one third of infants were identified as being at risk (score between 70 and 85) on each subscale. Cerebral palsy was diagnosed in 4 (3.7%) of babies. Factors associated with poor outcome included cystic periventricular leukomalacia (PVL), resuscitation at birth, maternal parity, prolonged hospitalisation and duration of supplemental oxygen. PVL was associated with poor outcome on all three subscales. Birth weight and gestational age were not predictive of neurodevelopmental outcome. Although the neurodevelopmental outcome of this group of VLBW infants was within the normal range, with a low incidence of cerebral palsy, these results may reflect the low survival of babies with a birth weight below 900 grams. In addition, mean subscale scores were low and one third of the babies were identified as "at risk", indicating that this group of babies warrants long-term follow up into school going age.