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极低出生体重儿中 NEC 和 IVH 同时存在与神经发育结局的关系。

Association between neurodevelopmental outcomes and concomitant presence of NEC and IVH in extremely low birth weight infants.

机构信息

Boston Children's Hospital, Department of Surgery and Center for Advanced Intestinal Rehabilitation, Boston, MA, USA.

Vermont Oxford Network, Burlington, VT, USA.

出版信息

J Perinatol. 2024 Jan;44(1):108-115. doi: 10.1038/s41372-023-01780-8. Epub 2023 Sep 21.

DOI:10.1038/s41372-023-01780-8
PMID:37735208
Abstract

OBJECTIVE: To quantify the association between necrotizing enterocolitis (NEC) and neurodevelopmental disability (NDI) in extremely low birth weight (ELBW) infants with intraventricular hemorrhage (IVH). STUDY DESIGN: ELBW survivors born 2011-2017 and evaluated at 16-26 months corrected age in the Vermont Oxford Network (VON) ELBW Follow-Up Project were included. Logistic regression determined the adjusted relative risk (aRR) of severe NDI in medical or surgical NEC compared to no NEC, stratified by severity of IVH. RESULTS: Follow-up evaluation occurred in 5870 ELBW survivors. Compared to no NEC, medical NEC had no impact on NDI, regardless of IVH status. Surgical NEC increased risk of NDI in patients with no IVH (aRR 1.69; 95% CI 1.36-2.09), mild IVH (aRR 1.36;0.97-1.92), and severe IVH (aRR 1.35;1.13-1.60). CONCLUSIONS: ELBW infants with surgical NEC carry increased risk of neurodevelopmental disability within each IVH severity stratum. These data describe the additive insult of surgical NEC and IVH on neurodevelopment, informing prognostic discussions and highlighting the need for preventative interventions.

摘要

目的：定量研究伴有脑室周围出血（IVH）的极低出生体重儿（ELBW）中坏死性小肠结肠炎（NEC）与神经发育障碍（NDI）之间的关联。

研究设计：纳入 2011 年至 2017 年出生并在 Vermont Oxford Network（VON）ELBW 随访项目中于校正后 16-26 个月龄进行评估的 ELBW 幸存者。采用 logistic 回归确定与无 NEC 相比，医学 NEC 与手术 NEC 时严重 NDI 的调整后相对风险（aRR），并按 IVH 严重程度分层。

结果：ELBW 幸存者中有 5870 人进行了随访评估。与无 NEC 相比，无论 IVH 状态如何，医学 NEC 对 NDI 均无影响。无 IVH（aRR 1.69；95%CI 1.36-2.09）、轻度 IVH（aRR 1.36；0.97-1.92）和重度 IVH（aRR 1.35；1.13-1.60）的手术 NEC 增加了 NDI 的风险。

结论：伴有手术 NEC 的 ELBW 婴儿在每个 IVH 严重程度分层中都存在神经发育障碍的风险增加。这些数据描述了手术 NEC 和 IVH 对神经发育的附加损害，为预后讨论提供了信息，并强调了需要预防干预。

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Association between neurodevelopmental outcomes and concomitant presence of NEC and IVH in extremely low birth weight infants.

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本文引用的文献

[1]
Driving distances and loss to follow-up after hematopoietic cell transplantation.

EJHaem. 2021-3-4

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J Perinatol. 2022-2

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N Engl J Med. 2020-12-31

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J Pediatr Surg. 2020-2-29

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Lancet. 2019-2-14

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Curr Probl Surg. 2019-1

[9]
Racial disparities in clinic follow-up early in life among survivors of congenital heart disease.

Congenit Heart Dis. 2019-3

[10]
Neurodevelopmental outcomes following necrotizing enterocolitis.

Semin Fetal Neonatal Med. 2018-8-17

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