Huang Hai-Bo, Watt Man Joe, Hicks Matthew, Zhang Qian-Shen, Lin Fang, Wan Xue-Qing, Chow Chun-Bong, Cheung Po-Yin
Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Department of Pediatrics, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada.
Front Pediatr. 2022 Mar 17;10:840190. doi: 10.3389/fped.2022.840190. eCollection 2022.
Comprehensive multidisciplinary assessment of neurodevelopmental outcomes of high-risk neonates may have significant challenges in low- and middle-income countries, in addition to socio-cultural barriers. We aimed to compare the time to diagnosis of neurodevelopmental impairment (NDI) and cerebral palsy (CP) in preterm neonates (<29 weeks) at a multidisciplinary assessment and care (MDAC) clinic with that of a conventional high-risk infant follow-up clinic in China.
All eligible surviving very preterm neonates born at <29 weeks gestation at the University of Hong Kong-Shenzhen Hospital between January 2015 and December 2019 were followed up in conventional (2015-2017) and MDAC (2018-2020) clinics up to 2 years corrected age with clinical demographic information collected in a prospective database. The MDAC team used standardized developmental assessments. The rates and timing of diagnosing NDI and CP in two epochs were compared.
The rates of NDI and CP were not different in two epochs [NDI: 12 (50%) vs. 12 (41%); CP: 3 (12%) vs. 2 (7%) of 24 and 29 surviving infants assessed in conventional and MDAC clinics, respectively]. Infants in the MDAC clinic were diagnosed with NDI and CP earlier than those in the pre-MDAC epoch (6 vs. 14 months corrected age, respectively, < 0.05).
High-risk preterm neonates can be followed more effectively in a family-centered, child-friendly multidisciplinary clinic, leading to an earlier diagnosis of NDI and CP. Early counseling and interventions could be implemented accordingly.
除社会文化障碍外，中低收入国家对高危新生儿的神经发育结局进行全面多学科评估可能面临重大挑战。我们旨在比较中国一家多学科评估与护理（MDAC）诊所与一家传统高危婴儿随访诊所中，早产新生儿（<29周）神经发育障碍（NDI）和脑瘫（CP）的诊断时间。
对2015年1月至2019年12月在香港大学深圳医院出生的所有孕周<29周的符合条件的存活极早产新生儿，在传统诊所（2015 - 2017年）和MDAC诊所（2018 - 2020年）进行随访，直至矫正年龄2岁，并将临床人口统计学信息收集到前瞻性数据库中。MDAC团队采用标准化发育评估。比较两个时期NDI和CP的诊断率及诊断时间。
两个时期NDI和CP的诊断率无差异[在传统诊所和MDAC诊所分别评估的24例和29例存活婴儿中，NDI：12例（50%）对12例（41%）；CP：3例（12%）对2例（7%）]。MDAC诊所的婴儿比MDAC时代之前的婴儿更早被诊断出患有NDI和CP（矫正年龄分别为6个月和14个月，P<0.05）。
在以家庭为中心、对儿童友好的多学科诊所中，可以更有效地对高危早产新生儿进行随访，从而更早诊断出NDI和CP。可据此实施早期咨询和干预。
