Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Pediatrics, The Ohio State University Wexner Medical Center, Nationwide Children's Hospital, Columbus, OH, USA.
Dev Med Child Neurol. 2022 Apr;64(4):453-461. doi: 10.1111/dmcn.15050. Epub 2021 Sep 16.
To determine whether infants with intrauterine drug exposure (IUDE) are similarly at risk for cerebral palsy (CP) as other high-risk populations, whether CP classification differs based on IUDE status, and describe the association of CP with specific substances among exposed infants.
This was a retrospective analysis of infants in a high-risk follow-up program (n=5578) between January 2014 and February 2018 with a history of IUDE or who received a CP diagnosis. CP rates were compared using two-sample z-tests. CP classification was assessed using Fisher's exact, Cochran-Armitage, and Wilcoxon rank-sum tests. Models for CP risk were assessed using multivariable logistic regression.
Among all infants with IUDE (n=1086), 53.8% were male with a mean (SD) birth gestational age of 36.8 (3.6) weeks. Among unexposed infants with CP (n=259), 54.4% were male with a mean (SD) birth gestational age of 29.9 (5.7) weeks. Opioids were the most common exposure (93.7%) of all infants with IUDE. The CP rate in the IUDE (5.2%) and unexposed (5.7%) high-risk populations were not significantly different (p=0.168), nor were there differences in CP typology, topography, or severity between exposed (n=57) and unexposed (n=259) infants (all p>0.05). In patients with IUDE and after controlling for established CP risk factors, the observed odds of CP varied among substances.
We suggest that IUDE should be considered a 'newborn-detectable risk' in the guidelines for the early detection of CP.
确定宫内药物暴露 (IUDE) 的婴儿是否与其他高危人群一样面临脑瘫 (CP) 的风险，CP 分类是否基于 IUDE 状态而有所不同，并描述暴露婴儿中 CP 与特定物质的关系。
这是对 2014 年 1 月至 2018 年 2 月期间高危随访计划中（n=5578）有 IUDE 史或 CP 诊断史的婴儿的回顾性分析。使用双样本 z 检验比较 CP 发生率。使用 Fisher 精确检验、Cochran-Armitage 检验和 Wilcoxon 秩和检验评估 CP 分类。使用多变量逻辑回归评估 CP 风险模型。
在所有 IUDE 婴儿中（n=1086），53.8%为男性，平均（SD）胎龄为 36.8（3.6）周。在无暴露 CP 婴儿中（n=259），54.4%为男性，平均（SD）胎龄为 29.9（5.7）周。阿片类药物是所有 IUDE 婴儿中最常见的暴露物（93.7%）。IUDE（5.2%）和无暴露（5.7%）高危人群中的 CP 发生率无显著差异（p=0.168），暴露（n=57）和无暴露（n=259）婴儿的 CP 类型、部位或严重程度也无差异（均 p>0.05）。在 IUDE 患者中，在控制了已确立的 CP 危险因素后，观察到 CP 的发生几率因物质而异。
我们建议 IUDE 应在 CP 早期检测指南中被视为“新生儿可检测风险”。
