Hintz Susan R, Kendrick Douglas E, Stoll Barbara J, Vohr Betty R, Fanaroff Avroy A, Donovan Edward F, Poole W Kenneth, Blakely Martin L, Wright Linda, Higgins Rosemary
Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 750 Welch Rd, Suite 315, Palo Alto, CA 94304, USA.
Pediatrics. 2005 Mar;115(3):696-703. doi: 10.1542/peds.2004-0569.
OBJECTIVES: Necrotizing enterocolitis (NEC) is a significant complication for the premature infant. However, subsequent neurodevelopmental and growth outcomes of extremely low birth weight (ELBW) infants with NEC have not been well described. We hypothesized that ELBW infants with surgically managed (SurgNEC) are at greater risk for poor neurodevelopmental and growth outcomes than infants with medically managed NEC (MedNEC) compared with infants without a history of NEC (NoNEC). The objective of this study was to compare growth, neurologic, and cognitive outcomes among ELBW survivors of SurgNEC and MedNEC with NoNEC at 18 to 22 months' corrected age. METHODS: Multicenter, retrospective analysis was conducted of infants who were born between January 1, 1995, and December 31, 1998, and had a birth weight <1000 g in the National Institute of Child Health and Human Development Neonatal Research Network Registry. Neurodevelopment and growth were assessed at 18 to 22 months' postmenstrual age. chi2, t test, and logistic regression analyses were used. RESULTS: A total of 2948 infants were evaluated at 18 to 22 months, 124 of whom were SurgNEC and 121 of whom were MedNEC. Compared with NoNEC, both SurgNEC and MedNEC infants were of lower birth weight and had a greater incidence of late sepsis; SurgNEC but not MedNEC infants were more likely to have received a diagnosis of cystic periventricular leukomalacia and bronchopulmonary dysplasia and been treated with postnatal steroids. Weight, length, and head circumference <10 percentile at 18 to 22 months were significantly more likely among SurgNEC but not MedNEC compared with NoNEC infants. After correction for anthropometric measures at birth and adjusted age at follow-up, all growth parameters at 18 to 22 months for SurgNEC but not MedNEC infants were significantly less than for NoNEC infants. SurgNEC but not MedNEC was a significant independent risk factor for Mental Developmental Index <70 (odds ratio [OR]: 1.61; 95% confidence interval [CI]: 1.05-2.50), Psychomotor Developmental Index <70 (OR: 1.95; 95% CI: 1.25-3.04), and neurodevelopmental impairment (OR: 1.78; 95% CI: 1.17-2.73) compared with NoNEC. CONCLUSIONS: Among ELBW infants, SurgNEC is associated with significant growth delay and adverse neurodevelopmental outcomes at 18 to 22 months' corrected age compared with NoNEC. MedNEC does not seem to confer additional risk. SurgNEC is likely to be associated with greater severity of disease.
目的：坏死性小肠结肠炎（NEC）是早产儿的一种严重并发症。然而，极低出生体重（ELBW）且患有NEC的婴儿随后的神经发育和生长结局尚未得到充分描述。我们假设，与无NEC病史的婴儿（NoNEC）相比，接受手术治疗的ELBW婴儿（SurgNEC）比接受保守治疗的NEC婴儿（MedNEC）出现不良神经发育和生长结局的风险更高。本研究的目的是比较SurgNEC和MedNEC的ELBW存活者与NoNEC在矫正年龄18至22个月时的生长、神经和认知结局。 方法：对1995年1月1日至1998年12月31日期间出生、出生体重<1000g且在国立儿童健康与人类发展研究所新生儿研究网络登记处登记的婴儿进行多中心回顾性分析。在月经后年龄18至22个月时评估神经发育和生长情况。采用卡方检验、t检验和逻辑回归分析。 结果：共有2948名婴儿在18至22个月时接受评估，其中124名是SurgNEC，121名是MedNEC。与NoNEC相比，SurgNEC和MedNEC婴儿的出生体重均较低，晚期败血症的发生率更高；SurgNEC婴儿（而非MedNEC婴儿）更有可能被诊断为脑室周围白质软化症和支气管肺发育不良，并接受产后类固醇治疗。与NoNEC婴儿相比，SurgNEC婴儿在18至22个月时体重、身长和头围低于第10百分位数的可能性显著更高，而MedNEC婴儿则不然。在校正出生时的人体测量指标和随访时的矫正年龄后，SurgNEC婴儿在18至22个月时的所有生长参数均显著低于NoNEC婴儿，而MedNEC婴儿则不然。与NoNEC相比，SurgNEC是智力发育指数<70（优势比[OR]：1.61；95%置信区间[CI]：1.05 - 2.50）、心理运动发育指数<70（OR：1.95；95%CI：1.25 - 3.04）和神经发育障碍（OR：1.78；95%CI：1.17 - 2.73）的显著独立危险因素。 结论：在ELBW婴儿中，与NoNEC相比，SurgNEC在矫正年龄18至22个月时与显著的生长延迟和不良神经发育结局相关。MedNEC似乎不会带来额外风险。SurgNEC可能与更严重的疾病相关。
Ital J Pediatr. 2025-8-2
Nutrients. 2025-5-26
Am J Perinatol. 2025-4-12
Zotero 插件