Neonatal Intensive Care Unit, Assistance Publique - Hôpitaux de Paris, Paris Cité University, Cochin Hospital, 53 Avenue de L'Observatoire, Paris, 75014, France.
Paris Cité University, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, Paris, 75006, France.
Eur J Pediatr. 2024 Sep;183(9):4019-4028. doi: 10.1007/s00431-024-05675-4. Epub 2024 Jul 2.
The primary objective was to evaluate the impact of necrotising enterocolitis (NEC) and spontaneous intestinal perforation (SIP) on mortality and neurodevelopmental outcomes at 2 years' corrected age (CA) in infants born before 32 weeks' gestation (WG).
We studied neurodevelopment at 2 years' CA of infants with NEC or SIP who were born before 32 WG from the EPIPAGE-2 cohort study. The primary outcome was death or the presence of moderate-to-severe motor or sensory disability defined by moderate-to-severe cerebral palsy or hearing or visual disability. The secondary outcome was developmental delay defined by a score < 2 SDs below the mean for any of the five domains of the Ages and Stages Questionnaire.
At 2 years' CA, 46% of infants with SIP, 34% of infants with NEC, and 14% of control infants died or had a moderate-to-severe sensorimotor disability (p < 0.01). This difference was mainly due to an increase in in-hospital mortality in the infants with SIP or NEC. Developmental delay at 2 years' CA was more frequent for infants with SIP than controls (70.8% vs 44.0%, p = 0.02) but was similar for infants with NEC and controls (49.3% vs 44.0%, p = 0.5). On multivariate analysis, the likelihood of developmental delay was associated with SIP (adjusted odds ratio = 3.0, 95% CI 1.0-9.1) but not NEC as compared with controls.
NEC and SIP significantly increased the risk of death or sensorimotor disability at 2 years' CA. SIP was also associated with risk of developmental delay at 2 years' CA.
本研究主要目的在于评估坏死性小肠结肠炎（NEC）和自发性肠穿孔（SIP）对 32 周前出生早产儿校正 2 年龄（CA）时死亡率和神经发育结局的影响。
我们研究了来自 EPIPAGE-2 队列研究的 32 周前出生患有 NEC 或 SIP 的婴儿在 2 年 CA 时的神经发育情况。主要结局为死亡或存在中重度运动或感觉残疾，定义为中重度脑瘫或听力或视力障碍。次要结局为发育迟缓，定义为在年龄和阶段问卷的任何五个领域中得分低于平均值 2 个标准差。
在 2 年 CA 时，SIP 组婴儿中 46%、NEC 组婴儿中 34%和对照组婴儿中 14%死亡或存在中重度感觉运动残疾（p<0.01）。这种差异主要是由于 SIP 或 NEC 组婴儿住院死亡率增加所致。与对照组相比，SIP 组婴儿在 2 年 CA 时发育迟缓更为常见（70.8% vs. 44.0%，p=0.02），而 NEC 组婴儿与对照组相似（49.3% vs. 44.0%，p=0.5）。多变量分析显示，与对照组相比，SIP 与发育迟缓的发生相关（调整优势比=3.0，95%CI 1.0-9.1），而 NEC 与对照组相比则无此相关性。
NEC 和 SIP 显著增加了 2 年 CA 时死亡或感觉运动残疾的风险。SIP 还与 2 年 CA 时发育迟缓的风险相关。
