Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
Pediatrics. 2017 Jul;140(1). doi: 10.1542/peds.2017-0216.
To evaluate the association between head growth (HG) during neonatal and postdischarge periods and neurodevelopmental outcomes of preterm neonates of <29 weeks gestational age.
METHODS: We conducted a retrospective cohort study of infants <29 weeks gestational age admitted between 2009 and 2011 to participating Canadian Neonatal Network units and followed by Canadian Neonatal Follow-Up Network clinics. Differences in head circumference (ΔHC) z score were calculated for 3 time periods, which include admission to discharge, discharge to follow-up at 16-36 months, and admission to follow-up. These were categorized in 1 reference group (ΔHC z score between -1 and +1) and 4 study groups (ΔHC z score of <-2, between -2 to -1, +1 to +2, and >+2). Neurodevelopmental outcomes were compared with the reference group.
1973 infants met the inclusion criteria. Poor HG occurred frequently during the NICU admission (ΔHC z score <-2 in 24% infants versus 2% infants post-discharge) with a period of "catch-up" growth postdischarge. Significant neurodevelopmental impairment was higher in infants with the poorest HG from admission to follow-up (adjusted odds ratio 2.18, 95% confidence interval 1.50-3.15), specifically cognitive and motor delays. Infants with poor initial HG and catch-up postdischarge have a lower adjusted odds ratio of significant neurodevelopmental impairment (0.35, 95% CI 0.16-0.74). Infants with poor HG received a longer duration of parenteral nutrition and mechanical ventilation and had poor weight gain.
Poor HG during the neonatal and postdischarge periods was associated with motor and cognitive delays at 16 to 36 months.
评估新生儿期和出院后期间头围生长（HG）与<29 周胎龄早产儿神经发育结局的关系。
我们对 2009 年至 2011 年期间在参与加拿大新生儿网络单位住院并由加拿大新生儿随访网络诊所随访的<29 周胎龄的婴儿进行了回顾性队列研究。计算了 3 个时间段的头围（ΔHC）z 评分差异，包括入院至出院、出院至 16-36 个月随访和入院至随访。这些被分为 1 个参考组（ΔHC z 评分在-1 到+1 之间）和 4 个研究组（ΔHC z 评分<-2、-2 到-1、+1 到+2 和>+2）。将神经发育结果与参考组进行比较。
1973 名婴儿符合纳入标准。新生儿重症监护病房（NICU）入院期间 HG 不良较为常见（ΔHC z 评分<-2 的婴儿占 24%，出院后占 2%），随后出现了出院后的“追赶性”生长。从入院到随访，HG 最差的婴儿神经发育损伤显著更高（校正比值比 2.18，95%置信区间 1.50-3.15），特别是认知和运动迟缓。初始 HG 不良且出院后追赶的婴儿，神经发育损伤显著的校正比值比较低（0.35，95%置信区间 0.16-0.74）。HG 不良的婴儿接受了更长时间的肠外营养和机械通气，体重增长不良。
新生儿期和出院后期间 HG 不良与 16 至 36 个月时的运动和认知迟缓有关。
