Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review.
Long-term neurodevelopmental outcomes after intrauterine and neonatal insults: a systematic review.
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DOI：
10.1016/s0140-6736(11)61577-8
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发表时间：
2012-02-04
期刊：
影响因子：
168.9
通讯作者：
Newton, Charles R. J. C.
中科院分区：
文献类型：
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作者：
Mwaniki, Michael K.;Atieno, Maurine;Lawn, Joy E.;Newton, Charles R. J. C.
新生儿干预措施主要侧重于降低死亡率和实现千年发展目标 4（儿童生存）。然而，人们对宫内和新生儿损伤的长期后果的全球负担知之甚少。我们进行了系统评价，以估计宫内和新生儿损伤后长期神经认知和其他后遗症的风险，特别是在低收入和中等收入国家。我们检索了 Medline、护理和联合健康文献累积索引、Cochrane 图书馆和 Embase，查找 1966 年 1 月 1 日至 2011 年 6 月 30 日期间发表的研究，这些研究报告了早产或新生儿损伤后的神经发育后遗症。对于未发表的研究和灰色文献，我们检索了国际论文摘要和世界卫生组织图书馆。我们回顾了具有定义的新生儿损伤后长期结果数据的出版物。我们用中位数和 IQR 总结了结果，并计算了侮辱后至少出现一种后遗症的风险。在我们检索到的 28 212 项研究中，有 153 项研究适合纳入，记录了 22 161 名宫内或新生儿损伤的幸存者。任何领域至少一种后遗症的总体中位风险为 39·4% (IQR 20·0–54·8)，任何损害领域至少一种严重损害的风险为 18·5% (7·7–33·3)，至少一种中度损害的风险为 5·0% (0·0–13·3%)，至少一种轻度损害的风险为 10·0% (1·4–17·9%)。与一种或多种所研究的损伤（不包括 HIV）相关的至少一种后遗症（加权平均值）的汇总风险估计为 37·0%（95% CI 27·0–48·0%），并且该风险不受地区、随访持续时间、研究设计或数据收集周期的显着影响。最常见的后遗症是学习困难、认知或发育迟缓（n=4032；59%）；脑瘫（n=1472；21%）；听力障碍（n=1340；20%）；和视力障碍（n=1228；18%）。只有 40 项 (26%) 研究包含多域损伤的数据。这些研究纳入了 2815 人，其中 1048 人（37%）有损伤，334 人（32%）有多重损伤。宫内和新生儿损伤极有可能导致严重的长期神经系统发病。应在资源匮乏地区进行可比队列研究，以正确评估这些疾病的负担以及慢性病等长期结果，并为政策和计划投资提供信息。比尔及梅琳达·盖茨基金会、拯救新生儿生命基金会和威康信托基金会。
Neonatal interventions are largely focused on reduction of mortality and progression towards Millennium Development Goal 4 (child survival). However, little is known about the global burden of long-term consequences of intrauterine and neonatal insults. We did a systematic review to estimate risks of long-term neurocognitive and other sequelae after intrauterine and neonatal insults, especially in low-income and middle-income countries. We searched Medline, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and Embase for studies published between Jan 1, 1966, and June 30, 2011, that reported neurodevelopmental sequelae after preterm or neonatal insult. For unpublished studies and grey literature, we searched Dissertation Abstracts International and the WHO library. We reviewed publications that had data for long-term outcome after defined neonatal insults. We summarised the results with medians and IQRs, and calculated the risk of at least one sequela after insult. Of 28 212 studies identified by our search, 153 studies were suitable for inclusion, documenting 22 161 survivors of intrauterine or neonatal insults. The overall median risk of at least one sequela in any domain was 39·4% (IQR 20·0–54·8), with a risk of at least one severe impairment in any insult domain of 18·5% (7·7–33·3), of at least one moderate impairment of 5·0% (0·0–13·3%), and of at least one mild impairment of 10·0% (1·4–17·9%). The pooled risk estimate of at least one sequela (weighted mean) associated with one or more of the insults studied (excluding HIV) was 37·0% (95% CI 27·0–48·0%) and this risk was not significantly affected by region, duration of the follow-up, study design, or period of data collection. The most common sequelae were learning difficulties, cognition, or developmental delay (n=4032; 59%); cerebral palsy (n=1472; 21%); hearing impairment (n=1340; 20%); and visual impairment (n=1228; 18%). Only 40 (26%) studies included data for multidomain impairments. These studies included 2815 individuals, of whom 1048 (37%) had impairments, with 334 (32%) having multiple impairments. Intrauterine and neonatal insults have a high risk of causing substantial long-term neurological morbidity. Comparable cohort studies in resource-poor regions should be done to properly assess the burden of these conditions, and long-term outcomes, such as chronic disease, and to inform policy and programme investments. The Bill & Melinda Gates Foundation, Saving Newborn Lives, and the Wellcome Trust.