Department of Pediatrics, Tufts University School of Medicine, Boston, MA.
Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Pediatr. 2024 Aug;271:114037. doi: 10.1016/j.jpeds.2024.114037. Epub 2024 Apr 4.
To identify perinatal factors in children born extremely preterm (EP) that were associated with motor impairment (MI) at 2 and 10 years of age and develop a predictive algorithm to estimate the risk of MI during childhood.
Participants of the Extremely Low Gestational Age Newborns Study (ELGANS) were classified as: no MI, MI only at 2 years, MI only at 10 years, and MI at both 2 and 10 years, based on a standardized neurological examination at 2 and the Gross Motor Function Classification System (GMFCS) at 10 years of age. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to develop the final predictive model.
Of the 849 study participants, 64 (7.5%) had a diagnosis of MI at both 2 and 10 years and 63 (7.4%) had a diagnosis of MI at 1 visit but not the other. Of 22 total risk factors queried, 4 variables most reliably and accurately predicted MI: gestational age, weight z-score growth trajectory during neonatal intensive care unit (NICU) stay, ventriculomegaly, and cerebral echolucency on head ultrasound. By selecting probability thresholds of 3.5% and 7.0% at ages 2 and 10, respectively, likelihood of developing MI can be predicted with a sensitivity and specificity of 71.2%/72.1% at age 2 and 70.7%/70.7% at age 10.
In our cohort, the diagnosis of MI at 2 years did not always predict a diagnosis of MI at 10 years. Specific risk factors are predictive of MI and can estimate an individual infant's risk at NICU discharge of MI at age 10 years.
确定极早产儿（EP）的围产期因素，这些因素与 2 岁和 10 岁时的运动障碍（MI）相关，并制定预测算法来估计儿童期 MI 的风险。
ELGANS 研究的参与者根据 2 岁时的标准化神经检查和 10 岁时的粗大运动功能分类系统（GMFCS）分为：无 MI、仅 2 岁时 MI、仅 10 岁时 MI 以及 2 岁和 10 岁时 MI。最小绝对收缩和选择算子（LASSO）回归用于开发最终预测模型。
在 849 名研究参与者中，64 名（7.5%）在 2 岁和 10 岁时均被诊断为 MI，63 名（7.4%）在 1 次就诊时被诊断为 MI，但在另一次就诊时未被诊断为 MI。在总共询问的 22 个危险因素中，有 4 个变量可以最可靠和准确地预测 MI：胎龄、新生儿重症监护病房（NICU）期间体重 z 分数的生长轨迹、脑室扩大和头部超声的脑回声不透明。通过分别选择 2 岁和 10 岁时的概率阈值为 3.5%和 7.0%，可以以 71.2%/72.1%的敏感性和特异性在 2 岁时和 70.7%/70.7%的特异性在 10 岁时预测 MI 的发生。
在我们的队列中，2 岁时的 MI 诊断并不总是预示着 10 岁时的 MI 诊断。特定的危险因素可预测 MI，并可估计婴儿在 NICU 出院时在 10 岁时发生 MI 的风险。
