Division of High Risk Pregnancy, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Engineering and College of Medicine, National Taiwan University, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
Taiwan J Obstet Gynecol. 2013 Sep;52(3):323-8. doi: 10.1016/j.tjog.2012.04.039.
The aim of this study was to investigate the 2-year neurological outcome of very-low-birth-weight (VLBW) children who had abnormal umbilical blood flow velocity prenatally.
We performed a prospective collection of infants prenatally diagnosed with abnormal umbilical blood flow velocity at a tertiary referral center from January 1, 2001 to September 30, 2005. VLBW children with prenatal absent or reversed end-diastolic flow velocity (AREDV) in the umbilical artery were investigated and compared with two similar demographic control groups of VLBW children without AREDV: one group with fetal growth restriction and the other without it. A follow-up study at 2 years of age for Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI) of the Bayley Scales among the three groups was analyzed.
Twenty-four VLBW children were identified to have AREDV prenatally, of whom four died during the neonatal period. After 2 years, five children were lost to follow-up and 15 were rescued, of whom 11 had absent end-diastolic velocity and four reversed end-diastolic velocity. We compared the remaining 15 children with the two control groups [28 children in the matched control group with intrauterine fetal growth restriction (IUGR), and 38 children in the matched control group without IUGR], and no significant differences were found in MDI (p = 0.938) and PDI (p = 0.496) scores at 2 years of age. However, we also surveyed the children with a gestational age of ≤ 29 weeks and found a significant difference in MDI scores (p = 0.048), but not in PDI scores (p = 0.219), among the three groups.
VLBW children delivered earlier than 29 gestational weeks with abnormal umbilical blood flow velocity prenatally have greater mental developmental delay at 2 years of age.
本研究旨在探讨产前脐动脉血流速度异常的极低出生体重儿（VLBW）的 2 年神经学预后。
我们在 2001 年 1 月 1 日至 2005 年 9 月 30 日期间，在一家三级转诊中心前瞻性地收集了产前诊断为脐动脉血流速度异常的婴儿。研究了 VLBW 儿童的产前脐动脉无舒张末期血流速度（AREDV）或反向舒张末期血流速度（REDEV），并与两组具有相似人口统计学特征但无 AREDV 的 VLBW 儿童进行了比较：一组为胎儿生长受限（FGR），另一组为无 FGR。对三组婴儿的贝利婴幼儿发展量表（Bayley Scales）进行了 2 年的智力发育指数（MDI）和运动发育指数（PDI）的随访研究。
24 例 VLBW 儿童产前出现 AREDV，其中 4 例在新生儿期死亡。2 年后，5 例儿童失访，15 例儿童得到随访，其中 11 例为无舒张末期血流速度，4 例为反向舒张末期血流速度。我们将其余 15 例儿童与两组对照组（28 例宫内生长受限（IUGR）匹配对照组，38 例无 IUGR 匹配对照组）进行比较，2 岁时 MDI（p = 0.938）和 PDI（p = 0.496）评分无显著差异。然而，我们还调查了胎龄≤29 周的儿童，发现三组儿童的 MDI 评分存在显著差异（p = 0.048），但 PDI 评分无显著差异（p = 0.219）。
胎龄＜29 周且产前脐动脉血流速度异常的 VLBW 儿童在 2 岁时精神发育迟缓更为明显。
