Smyrni Nikoletta, Koutsaki Maria, Petra Marianna, Nikaina Eirini, Gontika Maria, Strataki Helen, Davora Fotini, Bouza Helen, Damianos George, Skouteli Helen, Mastroyianni Sotiria, Dalivigka Zoi, Dinopoulos Argyris, Tzaki Margarita, Papavasiliou Antigone
Second Department of Neurology, University General Hospital of Thessaloniki AHEPA, Thessaloniki, Greece.
Third Pediatric Department, University General Hospital Attikon, Athens, Greece.
Front Neurol. 2021 Feb 12;12:628066. doi: 10.3389/fneur.2021.628066. eCollection 2021.
While most studies on the association of preterm birth and cerebral palsy (CP) have focused on very preterm infants, lately, attention has been paid to moderately preterm [32 to <34 weeks gestational age (GA)] and late preterm infants (34 to <37 weeks GA). In order to report on the outcomes of a cohort of moderately and late preterm infants, derived from a population-based CP Registry, a comparative analysis of data on 95 moderately preterm infants and 96 late preterm infants out of 1,016 with CP, was performed. Moderately preterm neonates with CP were more likely to have a history of N-ICU admission ( = 0.001) and require respiratory support ( < 0.001) than late preterm neonates. Birth weight was significantly related to early neonatal outcome with children with lower birth weight being more likely to have a history of N-ICU admission [moderately preterm infants ( = 0.006)/late preterm infants ( < 0.001)], to require ventilator support [moderately preterm infants ( = 0.025)/late preterm infants ( = 0.014)] and not to have neonatal seizures [moderately preterm infants ( = 0.044)/late preterm infants ( = 0.263)]. In both subgroups, the majority of children had bilateral spastic CP with moderately preterm infants being more likely to have bilateral spastic CP and less likely to have ataxic CP as compared to late preterm infants ( = 0.006). The prevailing imaging findings were white matter lesions in both subgroups, with statistically significant difference between moderately preterm infants who required ventilator support and mainly presented with this type of lesion vs. those who did not and presented with gray matter lesions, maldevelopments or miscellaneous findings. Gross motor function was also assessed in both subgroups without significant difference. Among late preterm infants, those who needed N-ICU admission and ventilator support as neonates achieved worse fine motor outcomes than those who did not. Low birth weight is associated with early neonatal problems in both moderately and late preterm infants with CP. The majority of children had bilateral spastic CP and white matter lesions in neuroimaging. GMFCS levels were comparable in both subgroups while BFMF was worse in late preterm infants with a history of N-ICU admission and ventilator support.
虽然大多数关于早产与脑瘫（CP）关联的研究都集中在极早早产儿身上，但最近，中度早产[孕龄（GA）32至<34周]和晚期早产婴儿（GA 34至<37周）受到了关注。为了报告一组来自基于人群的脑瘫登记处的中度和晚期早产婴儿的结局，对1016例脑瘫患儿中的95例中度早产婴儿和96例晚期早产婴儿的数据进行了对比分析。与晚期早产新生儿相比，患有脑瘫的中度早产新生儿更有可能有新生儿重症监护病房（N-ICU）住院史（P = 0.001）并需要呼吸支持（P<0.001）。出生体重与早期新生儿结局显著相关，出生体重较低的儿童更有可能有N-ICU住院史[中度早产婴儿（P = 0.006）/晚期早产婴儿（P<0.001）]，需要呼吸机支持[中度早产婴儿（P = 0.025）/晚期早产婴儿（P = 0.014）]，且没有新生儿惊厥[中度早产婴儿（P = 0.044）/晚期早产婴儿（P = 0.263）]。在两个亚组中，大多数儿童患有双侧痉挛性脑瘫，与晚期早产婴儿相比，中度早产婴儿更有可能患有双侧痉挛性脑瘫，而患共济失调型脑瘫的可能性较小（P = 0.006）。主要的影像学表现是两个亚组均有白质病变，在需要呼吸机支持且主要表现为此类病变的中度早产婴儿与不需要呼吸机支持且表现为灰质病变、发育异常或其他杂项表现的中度早产婴儿之间存在统计学显著差异。两个亚组的粗大运动功能也进行了评估，无显著差异。在晚期早产婴儿中，那些新生儿期需要N-ICU住院和呼吸机支持的婴儿的精细运动结局比不需要的婴儿更差。低出生体重与患有脑瘫的中度和晚期早产婴儿的早期新生儿问题相关。大多数儿童患有双侧痉挛性脑瘫且神经影像学检查有白质病变。两个亚组的粗大运动功能分类系统（GMFCS）水平相当，而有N-ICU住院和呼吸机支持史的晚期早产婴儿的贝利婴幼儿发育量表（BFMF）评分更差。
