Department of Pediatrics, and
Department of Anatomy and Neurobiology, School of Medicine, Boston University, Boston, Massachusetts.
Pediatrics. 2021 May;147(5). doi: 10.1542/peds.2020-001040. Epub 2021 Apr 6.
Evidence-based care of extremely preterm infants (<28 weeks' gestation) depends heavily on research in which a primary outcome is infant neurodevelopmental impairment (NDI), yet it is unclear how well NDI in infancy predicts long-term NDI. In this study, we aim to assess the relationship between 2- and 10-year neurodevelopment using a well-known 2-year definition and a 10-year definition developed by an expert panel.
Using data from the Extremely Low Gestational Age Newborn Study cohort, we classified 2-year NDI using definitions developed by the National Institute of Child Health and Human Development Neonatal Research Network. We classified 10-year NDI using definitions developed by an expert panel, which added epilepsy and ASD at 10 years.
Of 1506 infants, 80% survived. Data sufficient to classify severity of NDI at both 2 and 10 years were available for 67% of survivors ( = 802). Among children classified as having moderate to severe NDI at 2 years, 63% had none to mild NDI at 10 years; among children classified as having profound NDI at 2 years, 36% had none to mild NDI at 10 years. Cohen's κ statistic indicated minimal to fair agreement between NDI at 2 and 10 years (0.34, < .001).
NDI in infancy, as defined in this study, only weakly predicts NDI in middle childhood. For the parents at risk for delivery of an extremely preterm infant, a hopeful message can be taken from our findings that one-third of surviving children classified as having profound NDI and nearly two-thirds of those classified as having moderate to severe NDI at 2 years had none to mild NDI at 10 years.
极早产儿（<28 周）的循证护理严重依赖于研究，而研究的主要结果是婴儿神经发育障碍（NDI），但目前尚不清楚婴儿期的 NDI 能在多大程度上预测长期的 NDI。本研究旨在使用知名的 2 岁定义和专家组制定的 10 岁定义评估婴儿期和 10 岁时的神经发育之间的关系。
利用超低胎龄新生儿研究队列的数据，我们使用美国国立儿童健康与人类发育研究所新生儿研究网络制定的定义来分类 2 岁时的 NDI。我们使用专家组制定的定义来分类 10 岁时的 NDI，该定义在 10 岁时增加了癫痫和 ASD。
在 1506 名婴儿中，80%存活。有 67%（=802）的幸存者有足够的数据可用于分类 2 岁和 10 岁时 NDI 的严重程度。在 2 岁时被归类为中重度 NDI 的儿童中，63%在 10 岁时无至轻度 NDI；在 2 岁时被归类为重度 NDI 的儿童中，36%在 10 岁时无至轻度 NDI。Cohen's κ 统计表明，2 岁和 10 岁时的 NDI 之间存在微小到公平的一致性（0.34，<.001）。
本研究中定义的婴儿期 NDI 仅能微弱预测儿童中期的 NDI。对于有分娩极早产儿风险的父母来说，我们的研究结果可以带来一线希望，即三分之一被归类为患有重度 NDI 的存活儿童和近三分之二被归类为在 2 岁时患有中重度 NDI 的儿童在 10 岁时无至轻度 NDI。
