Logan J W, Dammann O, Allred E N, Dammann C, Beam K, Joseph R M, O'Shea T M, Leviton A, Kuban K C K
Department of Pediatrics and Neonatology, Nationwide Children's Hospital, and The Ohio State University, Columbus, OH, USA.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
J Perinatol. 2017 May;37(5):606-614. doi: 10.1038/jp.2016.242. Epub 2017 Jan 12.
A neonatal illness severity score, The Score for Neonatal Acute Physiology-II (SNAP-II), predicts neurodevelopmental impairments at two years of age among children born extremely preterm. We sought to evaluate to what extent SNAP-II is predictive of cognitive and other neurodevelopmental impairments at 10 years of age.
In a cohort of 874 children born before 28 weeks of gestation, we prospectively collected clinical, physiologic and laboratory data to calculate SNAP-II for each infant. When the children were 10 years old, examiners who were unaware of the child's medical history assessed neurodevelopmental outcomes, including neurocognitive, gross motor, social and communication functions, diagnosis and treatment of seizures or attention deficit hyperactivity disorder (ADHD), academic achievement, and quality of life. We used logistic regression to adjust for potential confounders.
An undesirably high SNAP-II (⩾30), present in 23% of participants, was associated with an increased risk of cognitive impairment (IQ, executive function, language ability), adverse neurological outcomes (epilepsy, impaired gross motor function), behavioral abnormalities (attention deficit disorder and hyperactivity), social dysfunction (autistic spectrum disorder) and education-related adversities (school achievement and need for educational supports. In analyses that adjusted for potential confounders, Z-scores ⩽-1 on 11 of 18 cognitive outcomes were associated with SNAP-II in the highest category, and 6 of 18 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals ranged from 1.4 (1.01, 2.1) to 2.1 (1.4, 3.1). Similarly, 2 of the 8 social dysfunctions were associated with SNAP-II in the highest category, and 3 of 8 were associated with SNAP-II in the intermediate category. Odds ratios and 95% confidence intervals were slightly higher for these assessments, ranging from 1.6 (1.1, 2.4) to 2.3 (1.2, 4.6).
Among very preterm newborns, physiologic derangements present in the first 12 postnatal hours are associated with dysfunctions in several neurodevelopmental domains at 10 years of age. We are unable to make inferences about causality.
新生儿疾病严重程度评分系统——新生儿急性生理学评分第二版（SNAP-II）可预测极早产儿两岁时的神经发育障碍。我们试图评估SNAP-II在多大程度上能够预测10岁儿童的认知及其他神经发育障碍。
在一个由874名孕28周前出生的儿童组成的队列中，我们前瞻性地收集了临床、生理和实验室数据，以计算每名婴儿的SNAP-II。当这些儿童10岁时，对不了解其病史的检查人员进行神经发育结局评估，包括神经认知、大运动、社交和沟通功能、癫痫或注意力缺陷多动障碍（ADHD）的诊断与治疗、学业成绩及生活质量。我们使用逻辑回归来调整潜在的混杂因素。
23%的参与者存在不理想的高SNAP-II（⩾30），这与认知障碍（智商、执行功能、语言能力）、不良神经结局（癫痫、大运动功能受损）、行为异常（注意力缺陷障碍和多动）、社交功能障碍（自闭症谱系障碍）及教育相关困境（学业成绩和教育支持需求）风险增加相关。在调整潜在混杂因素的分析中，18项认知结局中有11项Z分数⩽ -1与最高类别中的SNAP-II相关，18项中有6项与中间类别中的SNAP-II相关。优势比和95%置信区间范围为1.4（1.01, 2.1）至2.1（1.4, 3.1）。同样，8项社交功能障碍中有2项与最高类别中的SNAP-II相关，8项中有3项与中间类别中的SNAP-II相关。这些评估的优势比和95%置信区间略高，范围为1.6（1.1, 2.4）至2.3（1.2, 4.6）。
在极早产儿中，出生后前12小时出现的生理紊乱与10岁时多个神经发育领域的功能障碍相关。我们无法推断因果关系。
