新生儿期使用保湿剂治疗早产儿对孟加拉国儿童神经发育的影响：一项观察性队列研究。
Impact of emollient therapy for preterm infants in the neonatal period on child neurodevelopment in Bangladesh: an observational cohort study.
机构信息
Prematurity Research Center, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, USA.
Clinical Neurosciences Center, Bangladesh Protibondhi Foundation, Dhaka, Bangladesh.
出版信息
J Health Popul Nutr. 2021 May 26;40(1):24. doi: 10.1186/s41043-021-00248-9.
BACKGROUND
Topical treatment with sunflower seed oil (SSO) or Aquaphor® reduced sepsis and neonatal mortality in hospitalized preterm infants <33 weeks' gestational age in Bangladesh. We sought to determine whether the emollient treatments improved neurodevelopmental outcomes during early childhood.
METHODS
497 infants were randomized to receive SSO, Aquaphor®, or neither through the neonatal period or hospital discharge. 159 infant survivors were enrolled in the longitudinal follow-up study using a validated Rapid Neurodevelopmental Assessment tool and the Bayley Scales of Infant Development II (BSID II) administered at three-monthly intervals for the first year and thereafter at six-monthly intervals. Lowess smoothing was used to display neurodevelopmental status across multiple domains by age and treatment group, and Generalized Estimating Equations (GEE) were used to compare treatment groups across age points.
RESULTS
123 children completed at least one follow-up visit. Lowess graphs suggest that lower proportions of children who received massage with either SSO or Aquaphor® had neurodevelopmental delays than control infants in a composite outcome of disabilities. In GEE analysis, infants receiving SSO showed a significant protective effect on the development of fine motor skills [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.86-0.98, p=0.006]. The Psychomotor Development Index (PDI) in the BSID II showed significantly lower disability rates in the Aquaphor group (23.6%) compared to the control (55.2%) (OR 0.21, 95% CI 0.06-0.72, p=0.004).
CONCLUSIONS
Emollient massage of very preterm, hospitalized newborn infants improved some child neurodevelopmental outcomes over the first 2 years of follow-up. Findings warrant further confirmatory research.
TRIAL REGISTRATION
ClinicalTrials.gov (98-04-21-03-2) under weblink https://clinicaltrials.gov/ct2/show/NCT00162747.
背景
在孟加拉国，局部使用葵花籽油（SSO）或 Aquaphor®治疗可降低住院早产儿（胎龄<33 周）的败血症和新生儿死亡率。我们旨在确定这种保湿治疗是否能改善婴幼儿期的神经发育结局。
方法
497 名婴儿随机接受 SSO、Aquaphor®或两者均不治疗，直至新生儿期或出院。159 名存活婴儿入组纵向随访研究，使用经过验证的快速神经发育评估工具和贝利婴幼儿发育量表第二版（BSID II）进行评估，在第一年每三个月评估一次，之后每六个月评估一次。使用低阶样条法（Lowess）按年龄和治疗组显示多个领域的神经发育状况，使用广义估计方程（GEE）比较各年龄点的治疗组。
结果
123 名儿童至少完成一次随访。Lowess 图表明，在残疾综合结局中，接受 SSO 或 Aquaphor®按摩的儿童神经发育延迟的比例低于对照组。在 GEE 分析中，接受 SSO 的婴儿在精细运动技能发育方面具有显著的保护作用[比值比（OR）0.92，95%置信区间（CI）0.86-0.98，p=0.006]。BSID II 的精神运动发育指数（PDI）显示，Aquaphor 组的残疾率明显低于对照组（23.6%对 55.2%）（OR 0.21，95% CI 0.06-0.72，p=0.004）。
结论
对住院极早产儿进行保湿按摩可改善婴儿神经发育结局，随访时间为 2 年。这些发现需要进一步的确认性研究。
试验注册
ClinicalTrials.gov（98-04-21-03-2），网址为 https://clinicaltrials.gov/ct2/show/NCT00162747。
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