Boluyt Nicole, van Kempen Anne, Offringa Martin
Center for Pediatric Clinical Epidemiology, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, The Netherlands.
Pediatrics. 2006 Jun;117(6):2231-43. doi: 10.1542/peds.2005-1919.
Our goal was to assess the effect of episodes of neonatal hypoglycemia on subsequent neurodevelopment.
We searched Medline and Embase for cohort studies on subsequent neurodevelopment after episodes of hypoglycemia in the first week of life. Reference lists of available studies were reviewed, and content experts were contacted for additional studies. Included studies were selected and appraised for methodologic quality by 2 reviewers. Methodologic quality was assessed according to well-accepted criteria for prognostic studies. Eventually, all studies were given an overall quality score: poor, moderate, or high quality. Studies in the latter 2 categories were considered for quantitative data analysis.
Eighteen eligible studies were identified. The overall methodologic quality of the included studies was considered poor in 16 studies and high in 2 studies. Pooling of results of the 2 high-quality studies was deemed inappropriate because of major clinical and methodologic heterogeneity. None of the studies provided a valid estimate of the effect of neonatal hypoglycemia on neurodevelopment. Building on the strengths and weaknesses of existing studies, we developed a proposal for an "optimal" future study design.
Recommendations for clinical practice cannot be based on valid scientific evidence in this field. To assess the effect of neonatal hypoglycemia on subsequent neurodevelopment, a well-designed prospective study should be undertaken. We submit a design for a study that may answer the still-open questions.
我们的目标是评估新生儿低血糖发作对后续神经发育的影响。
我们在Medline和Embase数据库中检索了关于出生后第一周低血糖发作后后续神经发育的队列研究。对现有研究的参考文献列表进行了审查，并联系了内容专家以获取更多研究。纳入的研究由2名评审员进行选择和方法学质量评估。根据广泛认可的预后研究标准评估方法学质量。最终，所有研究都获得了一个总体质量评分：差、中等或高质量。后两类研究被考虑进行定量数据分析。
共确定了18项符合条件的研究。纳入研究的总体方法学质量在16项研究中被认为较差，在2项研究中被认为较高。由于主要的临床和方法学异质性，将这2项高质量研究的结果合并被认为不合适。没有一项研究能够有效估计新生儿低血糖对神经发育的影响。基于现有研究的优缺点，我们提出了一个“最佳”未来研究设计的建议。
该领域的临床实践建议无法基于有效的科学证据。为了评估新生儿低血糖对后续神经发育的影响，应开展一项设计良好的前瞻性研究。我们提交了一项研究设计，该设计可能回答仍未解决的问题。
