Department of Neonatal Medicine, Rouen University Hospital, Rouen, France.
Pediatrics. 2010 Jan;125(1):e29-34. doi: 10.1542/peds.2009-0994. Epub 2009 Dec 21.
Low-dose aspirin (LDA) given during pregnancy may alter brain development in very preterm infants. We report the short- and long-term outcomes of very preterm infants according to LDA treatment.
Data were from the Etude Epidemiologique des Petites Ages Gestationnels (EPIPAGE) cohort study, which included all infants born before 33 weeks of gestation in 9 French regions in 1997. This study was restricted to 656 children who were born to 584 women with an obstetric history of placental vascular disease or with chronic hypertension or renal or autoimmune diseases. The main outcome measures were mortality, cerebral lesions, and outcome at 5 years of age, which were measured by a diagnosis of cerebral palsy; behavioral difficulties, which were assessed with the Strength and Difficulties Questionnaire; and cognitive impairment, which was measured by the mental processing composite scale of the Kaufman Assessment Battery for Children (an IQ-equivalent measure of cognitive ability in 2 dimensions: sequential and simultaneous processing scores).
LDA treatment was administered to 125 of 584 (21%) mothers and was not significantly associated with mortality, cerebral lesions, cerebral palsy, or global cognitive impairment of the children at 5 years of age. The proportion of low simultaneous processing scores (<70) was lower in the group with LDA (7% vs 19% without LDA; P = .04). This association was not significant after adjustment for propensity score, prognostic factors, and social class (adjusted odds ratio [aOR]: 0.59 [95% confidence interval (CI): 0.17-2.06]). LDA treatment was associated with a reduction, at the limit of significance, in total behavioral difficulties (aOR: 0.44 [95% CI: 0.19-1.02]) and hyperactivity (aOR: 0.43 [95% CI: 0.17-1.05]).
LDA was not associated with adverse neonatal or long-term outcomes. Moreover, the results suggest that LDA may be associated with a reduction in neurobehavioral difficulties. More research is needed to assess the effects of aspirin alone or combined with other neuroprotective agents.
孕期低剂量阿司匹林（LDA）的使用可能会改变极早产儿的大脑发育。我们根据 LDA 治疗报告极早产儿的短期和长期结局。
数据来自于 EPIPAGE 队列研究，该研究纳入了 1997 年法国 9 个地区所有胎龄小于 33 周的婴儿。本研究仅限于 656 名儿童，他们的母亲有胎盘血管疾病、慢性高血压、肾脏或自身免疫性疾病等产科病史。主要结局测量指标包括死亡率、脑损伤以及 5 岁时的结局，通过脑瘫的诊断来评估；行为困难，使用强弱困难问卷来评估；认知障碍，使用 Kaufman 儿童评估电池的心理处理综合量表（2 维认知能力的智商等效测量：顺序和同时处理分数）来测量。
在 584 名母亲中，有 125 名（21%）接受了 LDA 治疗，LDA 治疗与儿童 5 岁时的死亡率、脑损伤、脑瘫或整体认知障碍均无显著相关性。LDA 组中低同时处理分数（<70）的比例较低（7%比无 LDA 组的 19%；P=0.04）。经倾向评分、预后因素和社会阶层调整后，这种关联并不显著（调整后比值比[aOR]：0.59[95%置信区间（CI）：0.17-2.06]）。LDA 治疗与总行为困难（aOR：0.44[95%CI：0.19-1.02]）和多动（aOR：0.43[95%CI：0.17-1.05]）显著降低相关。
LDA 与不良新生儿或长期结局无关。此外，结果表明 LDA 可能与神经行为困难的减少有关。需要更多的研究来评估阿司匹林单独或与其他神经保护剂联合使用的效果。
