Division of Neonatal Medicine, Department of Pediatrics, Brown University, Providence, RI.
Division of Neonatal Medicine, Department of Pediatrics, Brown University, Providence, RI.
J Pediatr. 2019 Dec;215:41-49.e4. doi: 10.1016/j.jpeds.2019.07.063. Epub 2019 Sep 6.
To evaluate neurodevelopmental outcomes of preterm infants with need for Child Protective Services (CPS) supervision at hospital discharge compared with those discharged without CPS supervision.
For infants born at <27 weeks of gestation between 2006 and 2013, prospectively collected maternal and neonatal characteristics and 18- to 26-month corrected age follow-up data were analyzed. Bayley-III cognitive and language scores of infants with discharge CPS supervision were compared with infants without CPS supervision using regression analysis while adjusting for potentially confounding variables, including entering CPS after discharge from the hospital.
Of the 4517 preterm infants discharged between 2006 and 2013, 255 (5.6%) were discharged with a need for CPS supervision. Mothers of infants with CPS supervision were significantly more likely to be younger, single, and gravida ≥3; to have less than a high school education; and to have a singleton pregnancy and less likely to have received prenatal care or antenatal steroids. Despite similar birth weight and medical morbidities, the CPS group had longer hospital stays compared with the non-CPS group. In adjusted analysis, cognitive scores were points lower (B = -1.94; 95% CI, -3.88 to -0.08; P = .04) in the CPS at discharge group compared with the non-CPS group. In children who entered CPS supervision after hospital discharge (an additional 106 infants), cognitive scores were 4 points lower (β = -4.76; 95% CI, -7.47 to -2.05; P < .001) and language scores were 5 points lower (β = -4.93; 95% CI, -8.00 to -1.86; P = .002).
Extremely preterm infants discharged from the hospital with CPS supervision or entering CPS postdischarge are at increased risk for cognitive delay at 2 years of age. Opportunities exist to intervene and potentially improve outcomes in this vulnerable group of children.
评估与出院时无需儿童保护服务（CPS）监督的早产儿相比，因需要 CPS 监督而出院的早产儿的神经发育结局。
对 2006 年至 2013 年间出生于<27 周妊娠的婴儿，前瞻性收集母亲和新生儿特征以及 18 至 26 个月校正年龄的随访数据。采用回归分析比较出院时有 CPS 监督的婴儿和无 CPS 监督的婴儿的贝利-III 认知和语言评分，同时调整潜在的混杂变量，包括出院后进入 CPS。
在 2006 年至 2013 年间出院的 4517 名早产儿中，有 255 名（5.6%）因需要 CPS 监督而出院。CPS 监督组婴儿的母亲更年轻、单身、多胎妊娠≥3 次；教育程度较低；单胎妊娠，接受产前护理和产前类固醇的可能性较小。尽管出生体重和医疗合并症相似，但 CPS 组的住院时间长于非 CPS 组。在调整后的分析中，与非 CPS 组相比，CPS 组的认知评分低 1.94 分（B = -1.94；95%CI，-3.88 至 -0.08；P =.04）。在出院后进入 CPS 监督的儿童（另外 106 名儿童）中，认知评分低 4 分（β = -4.76；95%CI，-7.47 至 -2.05；P <.001），语言评分低 5 分（β = -4.93；95%CI，-8.00 至 -1.86；P =.002）。
出院时因 CPS 监督或出院后进入 CPS 的极早产儿，2 岁时认知延迟的风险增加。有机会对这一弱势群体的儿童进行干预并有可能改善结局。
