Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
J Matern Fetal Neonatal Med. 2022 Jan;35(2):372-378. doi: 10.1080/14767058.2020.1718647. Epub 2020 Jan 27.
To investigate the association between neonatal complications and neurophysiological development in twins at 18 and 48-60 months of age.
This was a secondary analysis of 841 Danish mono- and dichorionic diamniotic twins from a randomized controlled trial (PREDICT study), which included an assessment of the twin's neurophysiological development using the Ages and Stages Questionnaire (ASQ) that had been filled out by the parents at 18 and 48 or 60 months. The correlation within twin pairs was accounted for by the method of generalized estimating equation. Models were adjusted for maternal educational score and gestational age at delivery.
ASQ data were available for 823 children at 18 months and 425 children at 48 or 60 months. Low maternal educational score and preterm delivery <34 weeks were associated with a lower ASQ score at 48-60 months (-15.4 points (95%CI -26.4; -4.5) and -13.2 points (95%CI -23.8; -2.5), respectively). Neonatal sepsis and a compound of intraventricular hemorrhage, retinopathy of prematurity and necrotizing enterocolitis (IVH/ROP/NEC) were associated with lower ASQ score at 18 months (-15.3 points (95%CI -28.1; -2.5) and -30.8 points (95%CI -59.5; -2.1), respectively). Children with IVH/ROP/NEC had a lower ASQ score at 48-60 months (-34.2 points (95%CI -67.9; -0.6)). The associations were not specific to only one ASQ domain.
Several neonatal complications are associated with poorer neurophysiological development in twins during childhood, even after adjustment for gestational age at delivery.
探讨新生儿并发症与 18 个月及 48-60 个月龄双胎神经生理发育的关系。
本研究为丹麦一项随机对照试验（PREDICT 研究）的二次分析，共纳入 841 对单绒毛膜和双绒毛膜单卵双胎，采用家长填写的《年龄与阶段问卷》（ASQ）评估双胎的神经生理发育情况。采用广义估计方程法校正双胞胎内的相关性。采用模型调整母亲教育评分和分娩时的胎龄。
823 名儿童在 18 个月时、425 名儿童在 48 或 60 个月时提供了 ASQ 数据。母亲教育评分低和早产<34 周与 48-60 个月时 ASQ 评分较低相关（-15.4 分（95%CI -26.4；-4.5）和-13.2 分（95%CI -23.8；-2.5））。新生儿败血症和脑室周围出血、早产儿视网膜病变和坏死性小肠结肠炎（IVH/ROP/NEC）的复合症与 18 个月时 ASQ 评分较低相关（-15.3 分（95%CI -28.1；-2.5）和-30.8 分（95%CI -59.5；-2.1））。患有 IVH/ROP/NEC 的儿童在 48-60 个月时 ASQ 评分较低（-34.2 分（95%CI -67.9；-0.6））。这些关联并非仅存在于某一特定 ASQ 领域。
即使调整了分娩时的胎龄，一些新生儿并发症与儿童期双胎的神经生理发育较差有关。
