Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan.
Osaka Maternal and Child Health Information Center, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan.
Eur J Pediatr. 2022 Jun;181(6):2501-2511. doi: 10.1007/s00431-022-04450-7. Epub 2022 Mar 25.
This study aimed to evaluate the association of neonatal transfer with the risk of neurodevelopmental outcomes at 3 years of age. Data were obtained from the Japan Environment and Children's Study. A general population of 103,060 pregnancies with 104,062 fetuses was enrolled in the study in 15 Regional Centers between January 2011 and March 2014. Live-born singletons at various gestational ages, including term infants, without congenital anomalies who were followed up until 3 years were included. Neurodevelopmental impairment was assessed using the Ages and Stages Questionnaire, third edition (ASQ-3) at 3 years of age. Logistic regression was used to estimate the adjusted risk and 95% confidence interval (CI) for newborns with neonatal transfer. Socioeconomic and perinatal factors were included as potential confounders in the analysis. Among 83,855 live-born singletons without congenital anomalies, 65,710 children were studied. Among them, 2780 (4.2%) were transferred in the neonatal period. After adjustment for potential confounders, the incidence of neurodevelopmental impairment (scores below the cut-off value of all 5 domains in the ASQ-3) was higher in children with neonatal transfer compared with those without neonatal transfer (communication: 6.5% vs 3.5%, OR 1.42, 95% CI 1.19-1.70; gross motor: 7.6% vs 4.0%, OR 1.26, 95% CI 1.07-1.49; fine motor: 11.3% vs 7.1%, OR 1.19, 95% CI 1.03-1.36; problem solving: 10.8% vs 6.8%, OR 1.29, 95% CI 1.12-1.48; and personal-social: 6.2% vs 2.9%, OR 1.52, 95% CI 1.26-1.83). Conclusion: Neonatal transfer was associated with a higher risk of neurodevelopmental impairment at 3 years of age. What is Known: • Neonatal transfer after birth in preterm infants is associated with adverse short-term outcomes. • Long-term outcomes of outborn infants with neonatal transfer in the general population remain unclear. What is New: • This study suggests that neonatal transfer at birth is associated with an increased risk of neurodevelopmental impairment. • Efforts for referring high-risk pregnant women to higher level centers may reduce the incidence of neonatal transfer, leading to improved neurological outcomes in the general population.
本研究旨在评估新生儿转运与 3 岁时神经发育结局风险的关系。数据来自日本环境与儿童研究。2011 年 1 月至 2014 年 3 月，在 15 个地区中心，纳入了 103060 例妊娠和 104062 例胎儿的一般人群。纳入了各种胎龄的足月和近足月、无先天畸形、随访至 3 岁的活产单胎。在 3 岁时使用年龄与阶段问卷（ASQ-3）评估神经发育障碍。采用 logistic 回归估计新生儿转运组的新生儿神经发育障碍的调整风险比和 95%置信区间（CI）。将社会经济和围产期因素作为分析中的潜在混杂因素。在 83855 例无先天畸形的活产单胎中，有 65710 例儿童进行了研究。其中，2780 例（4.2%）在新生儿期转运。在调整潜在混杂因素后，与无新生儿转运的儿童相比，新生儿转运组神经发育障碍（ASQ-3 所有 5 个领域的评分低于临界值）的发生率更高（沟通：6.5% vs. 3.5%，OR 1.42，95%CI 1.19-1.70；粗大运动：7.6% vs. 4.0%，OR 1.26，95%CI 1.07-1.49；精细运动：11.3% vs. 7.1%，OR 1.19，95%CI 1.03-1.36；解决问题：10.8% vs. 6.8%，OR 1.29，95%CI 1.12-1.48；个人-社会：6.2% vs. 2.9%，OR 1.52，95%CI 1.26-1.83）。结论：新生儿转运与 3 岁时神经发育障碍的风险增加有关。已知：•早产儿出生后的新生儿转运与短期不良结局有关。•一般人群中，外出分娩的新生儿转运的长期结局尚不清楚。新发现：•本研究表明，出生时的新生儿转运与神经发育障碍风险增加有关。•努力将高危孕妇转介到更高水平的中心可能会降低新生儿转运的发生率，从而改善一般人群的神经发育结局。
