Mahabee-Gittens E Melinda, Priyanka Illapani Venkata Sita, Merhar Stephanie L, Kline-Fath Beth, Harun Nusrat, He Lili, Parikh Nehal A
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH.
Neurodevelopmental Disorders Prevention Center, The Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
J Pediatr. 2024 Apr;267:113908. doi: 10.1016/j.jpeds.2024.113908. Epub 2024 Jan 12.
To compare brain magnetic resonance imaging (MRI) biomarkers and neurodevelopmental test scores in infants born preterm with and without prenatal opioid exposure (POE).
We examined 395 preterm infants (≤32 weeks gestational age) who had term-equivalent brain MRIs, composite scores from the Bayley Scales of Infant and Toddler Development-III at 2 years corrected age, and POE data. MRI parameters included total/regional brain volumes and severe punctate white matter lesions (PWMLs). We conducted bivariable analysis and multivariable logistic regression analyses.
The mean ± SD gestational age was 29.3 ± 2.5 weeks; 35 (8.9%) had POE and 20 (5.1%) had severe PWML. Compared with unexposed infants, those with POE exhibited higher rates of severe PWML (17.1% vs 3.9%, respectively; P = .002); findings remained significant with an OR of 4.16 (95% CI, 1.26-13.68) after adjusting for confounders. On mediation analysis, the significant relationship between POE and severe PWML was not indirectly mediated through preterm birth/gestational age (OR, 0.93; 95% CI, 0.78-1.10), thus suggesting the association was largely driven by a direct adverse effect of POE on white matter. In multivariable analyses, POE was associated with a significantly lower score by -6.2 (95% CI, -11.8 to -0.6) points on the Bayley Scales of Infant and Toddler Development-III Motor subscale compared with unexposed infants.
POE was associated with severe PWML; this outcome may be a direct effect of POE rather than being mediated by premature birth. POE was also associated with worse motor development. Continued follow-up to understand the long-term effects of POE is warranted.
比较有和没有产前阿片类药物暴露（POE）的早产婴儿的脑磁共振成像（MRI）生物标志物和神经发育测试分数。
我们检查了395名孕周≤32周的早产婴儿，这些婴儿进行了足月等效脑MRI检查，在矫正年龄2岁时进行了贝利婴幼儿发展量表第三版的综合评分，并获取了POE数据。MRI参数包括全脑/局部脑容量以及重度点状白质病变（PWML）。我们进行了双变量分析和多变量逻辑回归分析。
平均胎龄±标准差为29.3±2.5周；35名（8.9%）有POE，20名（5.1%）有重度PWML。与未暴露婴儿相比，有POE的婴儿重度PWML发生率更高（分别为17.1%和3.9%；P = 0.002）；在调整混杂因素后，比值比为4.16（95%置信区间，1.26 - 13.68）时，结果仍具有显著性。在中介分析中，POE与重度PWML之间的显著关系并非通过早产/胎龄间接介导（比值比，0.93；95%置信区间，0.78 - 1.10），因此表明这种关联很大程度上是由POE对白质的直接不良影响驱动的。在多变量分析中，与未暴露婴儿相比，POE与贝利婴幼儿发展量表第三版运动子量表得分显著降低6.2分（95%置信区间，-11.8至-0.6）相关。
POE与重度PWML相关；这一结果可能是POE的直接作用，而非由早产介导。POE还与更差的运动发育相关。有必要持续随访以了解POE的长期影响。
