Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT.
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
Am J Obstet Gynecol. 2014 May;210(5):426.e1-9. doi: 10.1016/j.ajog.2014.01.046.
Neonatal diagnoses are often used as surrogate endpoints for longer-term outcomes. We sought to characterize the correlation between neonatal diagnoses and early childhood neurodevelopment.
We conducted secondary analysis of a multicenter randomized controlled trial of antenatal magnesium sulfate vs placebo administered to women at imminent risk for delivery <32.0 weeks to prevent death and cerebral palsy in their offspring. Singletons and twins delivering 23.0-33.9 weeks who survived to hospital discharge and had 2-year-old outcome data were included. Those surviving to age 2 years were assessed by trained physicians and the Bayley II Scales of Infant Development Mental Development and Psychomotor Development Indices. Neonatal diagnoses at the time of each baby's initial hospital discharge were examined singly and in combination to determine those most predictive of childhood neurodevelopmental impairment, defined as a childhood diagnosis of moderate/severe cerebral palsy and/or Bayley scores >2 SD below the mean. Data were analyzed by multiple regression models and area under receiver operating characteristic curves.
A total of 1771 children met criteria. Children were delivered at a mean of 29.4 weeks' gestation. In all, 459 (25.9%) had neurodevelopmental impairment. In models controlling for gestational age at delivery, maternal education, maternal race, tobacco/alcohol/drug use during pregnancy, randomization to magnesium, fetal sex, and chorioamnionitis, individual neonatal morbidities were moderately predictive of childhood neurodevelopmental impairment (best model area under receiver operating characteristic curve, 0.68; 95% confidence interval, 0.65-0.71). Combinations of 2, 3, and 4 morbidities did not improve the prediction of neurodevelopmental impairment.
Approximately 1 in 4 previously preterm children had neurodevelopmental impairment at age 2 years. Prediction of childhood outcomes from neonatal diagnoses remains imperfect.
新生儿的诊断常被用作长期结局的替代终点。我们旨在描述新生儿诊断与儿童早期神经发育之间的相关性。
我们对一项多中心、随机对照试验进行了二次分析，该试验对即将分娩的孕妇（孕周<32.0 周）进行产前硫酸镁与安慰剂治疗，以预防其子女的死亡和脑瘫。纳入了在 23.0-33.9 周分娩且存活至出院的单胎和双胎，且有 2 岁结局数据。通过接受过培训的医生和贝利婴幼儿发展量表第二版评估存活至 2 岁的儿童，评估其精神运动发育和精神发育指数。单独和综合检查每个婴儿首次出院时的新生儿诊断，以确定最能预测儿童神经发育障碍的诊断，儿童神经发育障碍定义为儿童期中度/重度脑瘫诊断和/或贝利评分低于均值 2 个标准差。通过多元回归模型和接收者操作特征曲线下面积进行数据分析。
共有 1771 名儿童符合标准。婴儿的平均胎龄为 29.4 周。共有 459 名（25.9%）有神经发育障碍。在控制分娩时胎龄、母亲教育程度、母亲种族、妊娠期间吸烟/饮酒/吸毒、随机分组到硫酸镁、胎儿性别和绒毛膜羊膜炎等因素的模型中，个体新生儿合并症对儿童神经发育障碍的预测能力中等（最佳模型的接收者操作特征曲线下面积为 0.68；95%置信区间，0.65-0.71）。2 种、3 种和 4 种合并症的组合并不能改善神经发育障碍的预测。
大约 1/4 以前早产的儿童在 2 岁时存在神经发育障碍。从新生儿诊断预测儿童结局仍然不完善。
