先天性膈疝患儿的生长轨迹与神经发育结局
Growth trajectory and neurodevelopmental outcome in infants with congenital diaphragmatic hernia.
作者信息
Antiel Ryan M, Lin Nan, Licht Daniel J, Hoffman Casey, Waqar Lindsay, Xiao Rui, Monos Stylianos, D'Agostino Jo Ann, Bernbaum Judy, Herkert Lisa M, Rintoul Natalie E, Peranteau William H, Flake Alan W, Adzick N Scott, Hedrick Holly L
机构信息
The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
The Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
出版信息
J Pediatr Surg. 2017 Dec;52(12):1944-1948. doi: 10.1016/j.jpedsurg.2017.08.063. Epub 2017 Sep 28.
PURPOSE
The purpose of this study was to evaluate the impact of impaired growth on short-term neurodevelopmental (ND) outcomes in CDH survivors.
METHODS
Between 9/2005-12/2014, 84 of 215 (39%) CDH survivors underwent ND assessment at 12months of age using the BSID-III.
RESULTS
Mean cognitive, language, and motor scores were 92.6±13.5, 87.1±11.6, and 87.0±14.4, respectively (normal 100±15). 51% of patients scored 1 SD below the population mean in at least one domain, and 13% scored 2 SD below the population mean. Group-based trajectory analysis identified two trajectory groups ('high' and 'low') for weight, length, and head circumference (HC) z-scores. (Fig. 1) 74% of the subjects were assigned to the 'high' trajectory group for weight, 77% to the 'high' height group, and 87% to the 'high' HC group, respectively. In multivariate analysis, longer NICU stay (p<0.01) was associated with lower cognitive scores. Motor scores were 11 points higher in the 'high' HC group compared to the 'low' HC group (p=0.05). Motor scores were lower in patients with longer NICU length of stay (p<0.001).
CONCLUSIONS
At 1 year, half of CDH survivors had a mild delay in at least one developmental domain. Low HC trajectory was associated with worse neurodevelopmental outcomes.
TYPE OF STUDY
Prognosis Study/Retrospective Study.
LEVEL OF EVIDENCE
Level II.
目的
本研究旨在评估生长发育受损对先天性膈疝（CDH）幸存者短期神经发育（ND）结局的影响。
方法
在2005年9月至2014年12月期间，215例CDH幸存者中的84例（39%）在12月龄时使用贝利婴幼儿发展量表第三版（BSID-III）进行了ND评估。
结果
平均认知、语言和运动得分分别为92.6±13.5、87.1±11.6和87.0±14.4（正常为100±15）。51%的患者在至少一个领域的得分比总体均值低1个标准差，13%的患者得分比总体均值低2个标准差。基于组的轨迹分析确定了体重、身长和头围（HC）z评分的两个轨迹组（“高”和“低”）。（图1）分别有74%的受试者被分配到体重的“高”轨迹组，77%被分配到身高的“高”轨迹组，87%被分配到头围的“高”轨迹组。在多变量分析中，新生儿重症监护病房（NICU）住院时间延长（p<0.01）与较低的认知得分相关。“高”HC组的运动得分比“低”HC组高11分（p=0.05）。NICU住院时间较长的患者运动得分较低（p<0.001）。
结论
1岁时，一半的CDH幸存者在至少一个发育领域有轻度延迟。低HC轨迹与更差的神经发育结局相关。
研究类型
预后研究/回顾性研究。
证据水平
二级。
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