Department of Pediatrics, McGill University, Montreal, Quebec, Canada.
Department of Pediatrics, Division of Neonatology, University of Toronto, Toronto, Ontario, Canada.
Pediatr Neurol. 2018 Mar;80:77-83. doi: 10.1016/j.pediatrneurol.2017.11.006. Epub 2017 Dec 13.
The goal of this study was to explore the association between neonatal infection and outcomes in children with cerebral palsy.
We conducted a retrospective cohort study using the Canadian CP Registry. Neonatal infection was defined as meeting one of the following criteria: (1) septicemia, (2) septic shock, or (3) administration of antibiotics for ≥10 days. Phenotypic profiles of children with cerebral palsy with and without an antecedent neonatal infection were compared. Subgroup analysis was performed, stratified by gestational age (term versus preterm).
Of the 1229 registry participants, 505 (41.1%) were preterm, and 192 (15.6%) met the criteria for neonatal infection with 29% of preterm children having a neonatal infection compared with 6.5% in term-born children. Children with prior neonatal infection were more likely to have a white matter injury (odds ratio 2.2, 95% confidence interval 1.5 to 3.2), spastic diplegic neurological subtype (odds ratio 1.6, 95% confidence interval 1.1 to 2.3), and sensorineural auditory impairment (odds ratio 2.1, 95% confidence interval 1.4 to 3.3). Among preterm children, neonatal infection was not associated with a difference in phenotypic profile. Term-born children with neonatal infection were more likely to have spastic triplegia or quadriplegia (odds ratio 2.4, 95% confidence interval 1.3 to 4.3), concomitant white matter and cortical injury (odds ratio 4.1, 95% confidence interval 1.6 to 10.3), and more severe gross motor ability (Gross Motor Function Classification System IV to V) (odds ratio 2.6, 95% confidence interval 1.4 to 4.8) compared with preterm children.
Findings suggest a role of systemic infection on the developing brain in term-born infants, and the possibility to develop targeted therapeutic and preventive strategies to reduce cerebral palsy morbidity.
本研究旨在探讨新生儿感染与脑瘫患儿结局的关系。
我们使用加拿大脑瘫注册中心进行了一项回顾性队列研究。新生儿感染的定义为符合以下标准之一：（1）败血症，（2）感染性休克，或（3）抗生素治疗≥10 天。比较脑瘫患儿有无新生儿感染的表型特征。按胎龄（足月与早产）进行亚组分析。
在 1229 名登记参与者中，505 名（41.1%）为早产儿，192 名（15.6%）符合新生儿感染标准，其中 29%的早产儿有新生儿感染，而足月出生的儿童为 6.5%。有既往新生儿感染的儿童更可能患有白质损伤（优势比 2.2，95%置信区间 1.5 至 3.2）、痉挛性双瘫神经亚型（优势比 1.6，95%置信区间 1.1 至 2.3）和感觉神经性听觉损伤（优势比 2.1，95%置信区间 1.4 至 3.3）。在早产儿中，新生儿感染与表型特征无差异。患有新生儿感染的足月出生儿童更可能患有痉挛性三肢瘫或四肢瘫（优势比 2.4，95%置信区间 1.3 至 4.3）、同时伴有白质和皮质损伤（优势比 4.1，95%置信区间 1.6 至 10.3）以及更严重的粗大运动能力（粗大运动功能分类系统 IV 至 V）（优势比 2.6，95%置信区间 1.4 至 4.8），与早产儿相比。
研究结果表明，全身性感染可能对足月出生婴儿的发育中的大脑有影响，有可能制定有针对性的治疗和预防策略来降低脑瘫发病率。
