Zhang Jun, Cao Mi, Yue Shaoting, Yan Jingmin, Shang Yanyan
Faculty of Nursing (Dr Zhang), Wuhan University School of Nursing, Wuhan, China (Messrs Yan and Cao); Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China (Ms Yue); and Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, China (Ms Shang).
Adv Neonatal Care. 2023 Apr 1;23(2):E50-E58. doi: 10.1097/ANC.0000000000001046. Epub 2022 Nov 21.
Although developmental supportive care is an effective approach to improve the long-term psychomotor and/or neurobehavioral function of preterm infants, very limited studies have focused on the impact of after-discharge developmental support. The underlying epigenetic changes are unclear.
This study aimed to explore the preliminary effect of an evidence-based Postdischarge Developmental Support Program (PDSP) on preterm infant neurodevelopment and underlying epigenetic changes, including brain-derived neurotrophic factor (BDNF) gene-related DNA methylation and expression.
In this randomized controlled pilot trial, the preterm infant-parent dyads were randomized into either the intervention group/PDSP group (n = 22) or the control group/usual care group (n = 22). The neurodevelopmental outcomes of preterm infants were measured by Ages & Stages Questionnaires. Urine BDNF concentration level was tested by the enzyme-linked immunosorbent assay. Infant saliva specimens were collected to analyze the methylation level of BDNF gene promoter I at pre- and postintervention test.
After PDSP intervention, the total neurodevelopmental and the 5 domain scores of the PDSP group were all significantly higher than those of the control group ( P < .05). The BDNF levels decreased significantly only within control group ( P = .01). The difference in BDNF concentration and methylation levels between groups was not statistically significant.
Postdischarge Developmental Support Program may promote the neurodevelopment of preterm infants but has no effect on BDNF's expression and gene methylation level at 3 months of corrected age. The epigenetic mechanism of PDSP needs further study using a larger sample and longer follow-up.
尽管发育支持性护理是改善早产儿长期心理运动和/或神经行为功能的有效方法，但很少有研究关注出院后发育支持的影响。其潜在的表观遗传变化尚不清楚。
本研究旨在探讨基于证据的出院后发育支持计划（PDSP）对早产儿神经发育及潜在表观遗传变化的初步影响，包括脑源性神经营养因子（BDNF）基因相关的DNA甲基化和表达。
在这项随机对照试验中，将早产儿-父母二元组随机分为干预组/PDSP组（n = 22）或对照组/常规护理组（n = 22）。通过年龄与发育阶段问卷测量早产儿的神经发育结局。采用酶联免疫吸附测定法检测尿BDNF浓度水平。收集婴儿唾液标本，分析干预前后BDNF基因启动子I的甲基化水平。
PDSP干预后，PDSP组的总神经发育得分及5个领域得分均显著高于对照组（P < 0.05）。仅对照组内BDNF水平显著下降（P = 0.01）。两组间BDNF浓度和甲基化水平的差异无统计学意义。
出院后发育支持计划可能促进早产儿的神经发育，但对矫正年龄3个月时BDNF的表达和基因甲基化水平无影响。需要采用更大样本和更长随访时间进一步研究PDSP的表观遗传机制。
