极早早产儿早期手术与足月 MRI 时的脑异常有关：倾向评分分析。
Early surgery in very preterm infants is associated with brain abnormalities on term MRI: a propensity score analysis.
机构信息
Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA.
出版信息
J Perinatol. 2023 Jul;43(7):877-883. doi: 10.1038/s41372-023-01645-0. Epub 2023 Mar 25.
OBJECTIVE
To investigate the association between exposure to surgery under general anesthesia and brain abnormalities and neurodevelopmental outcomes in very preterm infants.
STUDY DESIGN
This prospective observational study includes 392 infants born at or below 32 weeks' gestational age. Participants completed brain MRI at term-equivalent age and Bayley-III assessment at 2 years corrected age. We evaluated the independent effects of surgery on brain MRI abnormalities and neurodevelopmental outcomes after propensity score matching.
RESULTS
All infants completed brain MRI, and 341 (87%) completed neurodevelopmental testing. Forty-five received surgery. Surgery was associated with worse MRI abnormalities (p < 0.0001) but with none of the developmental outcomes after propensity score matching. The global brain abnormality score was associated with the Bayley Cognitive (p = 0.005) and Motor (p = 0.028) composite scores.
CONCLUSIONS
Very preterm infants exposed to surgery under general anesthesia were at higher risk of brain abnormalities on MRI at term.
目的
研究全身麻醉下手术暴露与极早产儿脑异常和神经发育结局之间的关系。
研究设计
这是一项前瞻性观察研究，纳入了 392 名胎龄在 32 周及以下的婴儿。参与者在胎龄相等时完成脑 MRI 检查，在 2 岁校正年龄时完成贝利-III 评估。我们在进行倾向评分匹配后，评估了手术对脑 MRI 异常和神经发育结局的独立影响。
结果
所有婴儿均完成了脑 MRI 检查，341 名（87%）完成了神经发育测试。45 名婴儿接受了手术。手术与更严重的 MRI 异常相关（p<0.0001），但与倾向评分匹配后的任何发育结局均无关。整体脑异常评分与贝利认知（p=0.005）和运动（p=0.028）综合评分相关。
结论
在全身麻醉下接受手术的极早产儿，在胎龄相等时进行 MRI 检查时，其脑异常的风险更高。
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