早产儿多次出生后感染可预测其运动通路在足月时的成熟延迟，且在 3 岁时运动功能结局更差。
Multiple Postnatal Infections in Newborns Born Preterm Predict Delayed Maturation of Motor Pathways at Term-Equivalent Age with Poorer Motor Outcomes at 3 Years.
机构信息
Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences & Mental Health, SickKids Research Institute, Toronto, Ontario, Canada.
Department of Pediatrics (Neurology), University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada; Neurosciences & Mental Health, SickKids Research Institute, Toronto, Ontario, Canada; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
出版信息
J Pediatr. 2018 May;196:91-97.e1. doi: 10.1016/j.jpeds.2017.12.041. Epub 2018 Feb 2.
OBJECTIVES
To evaluate whether the number of postnatal infections is associated with abnormal white matter maturation and poorer motor neurodevelopmental outcomes at 36 months of corrected age.
STUDY DESIGN
A prospective longitudinal cohort study was undertaken of 219 newborns born preterm at 24-32 weeks of gestational age recruited between 2006 and 2013 with magnetic resonance imaging of the brain both early in life and at term-equivalent age. Postnatal infection was defined as any clinical infection or positive culture ≥72 hours after birth. White matter maturation was assessed by magnetic resonance spectroscopic imaging, magnetic resonance diffusion tensor imaging, and tract-based spatial statistics. Neurodevelopmental outcomes were assessed in 175 (82% of survivors) infants with Bayley Scales of Infant and Toddler Development-III composite scores and Peabody Developmental Motor Scales at 35 months of corrected age (IQR 34-37 months). Infection groups were compared via the Fisher exact test, Kruskal-Wallis test, and generalized estimating equations.
RESULTS
Of 219 neonates born preterm (median gestational age 27.9 weeks), 109 (50%) had no postnatal infection, 83 (38%) had 1 or 2 infections, and 27 (12%) had ≥3 infections. Infants with postnatal infections had more cerebellar hemorrhage. Infants with ≥3 infections had lower N-acetylaspartate/choline in the white matter and basal ganglia regions, lower fractional anisotropy in the posterior limb of the internal capsule, and poorer maturation of the corpus callosum, optic radiations, and posterior limb of the internal capsule on tract-based spatial statistics analysis as well as poorer Bayley Scales of Infant and Toddler Development-III (P = .02) and Peabody Developmental Motor Scales, Second Edition, motor scores (P < .01).
CONCLUSIONS
In newborns born preterm, ≥3 postnatal infections predict impaired development of the motor pathways and poorer motor outcomes in early childhood.
目的
评估新生儿出生后感染的次数是否与 36 个月校正年龄时的白质成熟异常和较差的运动神经发育结果相关。
研究设计
这是一项前瞻性纵向队列研究，纳入了 2006 年至 2013 年间 24-32 周胎龄早产儿 219 例，他们在生命早期和足月时均接受了脑部磁共振成像检查。出生后感染的定义为出生后≥72 小时出现任何临床感染或阳性培养。通过磁共振波谱成像、磁共振扩散张量成像和基于束流的空间统计学来评估白质成熟度。在 175 例（幸存者的 82%）存活婴儿中，在 35 个月校正年龄时（IQR 34-37 个月）使用贝利婴幼儿发育量表-III 综合评分和佩珀发育运动量表评估神经发育结果。通过 Fisher 精确检验、Kruskal-Wallis 检验和广义估计方程比较感染组。
结果
在 219 例早产儿中（中位胎龄 27.9 周），109 例（50%）无出生后感染，83 例（38%）有 1 或 2 次感染，27 例（12%）有≥3 次感染。有出生后感染的婴儿更易发生小脑出血。感染≥3 次的婴儿白质和基底节区的 N-乙酰天冬氨酸/胆碱降低，内囊后肢的各向异性分数降低，胼胝体、视辐射和内囊后肢的基于束流的空间统计学分析的成熟度降低，贝利婴幼儿发育量表-III（P=0.02）和 Peabody 发育运动量表第二版运动评分也较差（P<0.01）。
结论
在早产儿中，出生后≥3 次感染预测运动通路发育受损和幼儿期运动结局较差。
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