Bright H Reeve, Babata Kikelomo, Allred Elizabeth N, Erdei Carmina, Kuban Karl C K, Joseph Robert M, O'Shea T Michael, Leviton Alan, Dammann Olaf
Tufts University School of Medicine, Boston, MA.
Department of Newborn Medicine, Tufts Medical Center, Boston, MA.
J Pediatr. 2017 Aug;187:43-49.e1. doi: 10.1016/j.jpeds.2017.04.045. Epub 2017 May 16.
To evaluate the difference in 10-year neurocognitive outcomes between extremely low gestational age newborns without bacteremia and those with suspected or confirmed late-onset bacteremia.
Neurocognitive function was evaluated at 10 years of age in 889 children born at <28 weeks of gestation and followed from birth. Definite (culture-positive) late-onset bacteremia during postnatal weeks 2-4 was identified in 223 children, and 129 children had suspected bacteremia.
Infants with the lowest gestational age and birth weight z-score had the highest prevalence of definite and suspected late-onset bacteremia. Compared with peers with no or suspected bacteremia, infants with definite bacteremia performed worse on tests of general cognitive ability, language, academic achievement, and executive function, even after adjustment for potential confounders. Adjustment for low IQ attenuated the associations between bacteremia and all dysfunctions at age 10 years. Children with suspected bacteremia did not differ appreciably from those with no evidence of bacteremia. The motor domain was unaffected.
Extremely low gestational age newborns who had definite late bacteremia during postnatal weeks 2-4 are at heightened risk of neurocognitive limitations at age 10 years.
评估出生时胎龄极低且无菌血症的新生儿与疑似或确诊迟发性菌血症的新生儿在10年神经认知结局方面的差异。
对889名孕周小于28周且自出生起接受随访的儿童在10岁时进行神经认知功能评估。223名儿童在出生后第2至4周被确诊（培养阳性）为迟发性菌血症，129名儿童有疑似菌血症。
胎龄和出生体重Z评分最低的婴儿确诊和疑似迟发性菌血症的患病率最高。与无菌血症或疑似菌血症的同龄人相比，确诊菌血症的婴儿在一般认知能力、语言、学业成绩和执行功能测试中的表现更差，即使在对潜在混杂因素进行调整之后也是如此。对低智商进行调整后，减弱了菌血症与10岁时所有功能障碍之间的关联。有疑似菌血症的儿童与无菌血症证据的儿童没有明显差异。运动领域未受影响。
在出生后第2至4周确诊为迟发性菌血症的极低胎龄新生儿在10岁时出现神经认知缺陷的风险增加。
