支气管肺发育不良相关肺动脉高压的早产儿在矫正年龄 18-24 个月时的发育结果。
Developmental outcomes of preterm infants with bronchopulmonary dysplasia-associated pulmonary hypertension at 18-24 months of corrected age.
机构信息
Department of Pediatrics, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea.
Department of Pediatrics, Seoul National University Children's Hospital, Seoul University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
出版信息
BMC Pediatr. 2019 Jan 17;19(1):26. doi: 10.1186/s12887-019-1400-3.
BACKGROUND
Owing to advances in the critical care of premature infants with bronchopulmonary dysplasia (BPD), BPD-associated pulmonary hypertension (PH) is becoming a growing concern. However, only few investigations were available on neurodevelopmental outcomes in preterm infants with PH. Therefore, this study aimed to identify the impact of PH on growth and neurodevelopment at 18-24 months of corrected age (CA).
METHODS
We retrospectively analyzed the medical records of 394 infants (aged < 28 weeks of gestation) admitted to the neonatal intensive care unit between 2005 and 2014. Among the surviving infants, 123 returned for follow-up evaluations including the Bayley Scales of Infant and Toddler Development, third Edition (Bayley-III) screening tests and growth assessment at 18-24 months of CA. Among the 81 infants with moderate or severe BPD, 20 met the criteria for PH. Baseline characteristics and outcomes were compared in infants who developed BPD-associated PH (PH group, n = 20) and moderate or severe BPD infants who did not develop PH (non-PH group, n = 61).
RESULTS
Compared to the non-PH group, the PH group showed significantly lower cognitive (85 vs. 95, p = 0.004), language (81 vs. 89, p = 0.040), and motor (88 vs. 94, p = 0.010) scores of the Bayley-III at 18-24 months of CA. Cognitive delay was found in 45.0% (9/20) of PH infants. In addition, z-scores of weight (- 1.4 ± 1.3 vs. -0.6 ± 1.1%, p = 0.011) and HC (- 1.2 ± 1.8 vs. 0.53 ± 1.0%, p = 0.035) were significantly lower in the BPD with PH group. With the subgroup analysis in infants with severe BPD only, the cognitive score was consistently lower and poorer and weight gain after discharge was identified in infants with PH and severe BPD.
CONCLUSION
PH was a worsening factor of non-optimal growth and poor neurodevelopmental outcome in preterm infants with BPD at 18-24 months of CA. Our findings suggest the importance of close developmental follow-up and recognition of that risk to help optimize the outcome of preterm infants with PH.
背景
由于对患有支气管肺发育不良（BPD）的早产儿的重症监护的进步，BPD 相关肺动脉高压（PH）正成为一个日益严重的问题。然而，仅有少数研究涉及患有 PH 的早产儿的神经发育结局。因此，本研究旨在确定 PH 对校正胎龄（CA）18-24 个月时的生长和神经发育的影响。
方法
我们回顾性分析了 2005 年至 2014 年间在新生儿重症监护病房住院的 394 名（胎龄<28 周）婴儿的病历。在幸存的婴儿中，有 123 名婴儿返回进行随访评估，包括贝利婴幼儿发育量表，第三版（Bayley-III）筛查测试和校正胎龄 18-24 个月时的生长评估。在 81 名患有中重度 BPD 的婴儿中，有 20 名符合 PH 标准。在患有 BPD 相关 PH（PH 组，n=20）和未发生 PH 的中重度 BPD 婴儿（非 PH 组，n=61）中比较了基线特征和结局。
结果
与非 PH 组相比，PH 组在校正胎龄 18-24 个月时的 Bayley-III 认知（85 与 95，p=0.004）、语言（81 与 89，p=0.040）和运动（88 与 94，p=0.010）评分明显较低。PH 婴儿中有 45.0%（9/20）存在认知障碍。此外，PH 组的体重 Z 评分（-1.4±1.3 与-0.6±1.1%，p=0.011）和头围 Z 评分（-1.2±1.8 与 0.53±1.0%，p=0.035）明显较低。仅在患有严重 BPD 的婴儿亚组分析中，认知评分始终较低且较差，并且 PH 和严重 BPD 婴儿出院后的体重增加情况。
结论
PH 是校正胎龄 18-24 个月时患有 BPD 的早产儿生长和神经发育结局不理想的加重因素。我们的研究结果表明，密切进行发育随访并认识到这种风险的重要性，有助于优化患有 PH 的早产儿的结局。
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