Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
Lancet Child Adolesc Health. 2018 Apr;2(4):281-289. doi: 10.1016/S2352-4642(17)30180-3. Epub 2018 Jan 10.
Over the past decade, evidence has emerged that children growing up after neonatal critical illness, irrespective of underlying diagnosis, are at risk of memory impairment and academic problems. These difficulties are manifest even when intelligence is within the normal range. In this Review, we propose a common neurodevelopmental pathway following neonatal critical illness by showing that survivors of preterm birth, congenital heart disease, and severe respiratory failure share an increased risk of long-term memory deficits and associated hippocampal alterations. Rather than a consequence of underlying diagnosis, we suggest that this shared vulnerability is probably related to common conditions associated with neonatal critical illness, including hypoxia, neuroinflammation, stress, exposure to anaesthetics, or a complex interplay of these factors at different postconceptional ages. Future work should be aimed at improvement of early identification of patients at risk and evaluation of intervention modalities, such as exercise or cognitive training.
在过去的十年中,有证据表明,即使智力处于正常范围内,患有新生儿危重病的儿童在成长过程中也面临记忆障碍和学业问题的风险。这些困难在早产儿、先天性心脏病和严重呼吸衰竭的幸存者中表现得尤为明显。通过显示早产儿、先天性心脏病和严重呼吸衰竭的幸存者都有长期记忆缺陷和相关海马体改变的风险,我们提出了一种新生儿危重病后的共同神经发育途径。我们认为,这种共同的脆弱性可能与新生儿危重病相关的共同条件有关,而不是潜在诊断的结果,包括缺氧、神经炎症、应激、麻醉暴露,或在不同的受孕后年龄这些因素的复杂相互作用。未来的工作应该旨在改善对高危患者的早期识别和评估干预方式,如运动或认知训练。