Early Biomarkers in the Prediction of Later Functional Impairment in Preterm Children With Cerebral Palsy

IF 3.2 3区 医学 Q2 CLINICAL NEUROLOGY
Gabrielle Lambert MD , Nafisa Husein MSc , Darcy Fehlings MD, MSc , John Andersen MD , Maryam Oskoui MD, MSc , Michael Shevell MDCM , Canadian Cerebral Palsy Registry
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引用次数: 0

Abstract

Background

To identify early biomarkers that could predict later functional capabilities in preterm children with later cerebral palsy (CP).

Methods

Data from 968 preterm children with later CP were extracted from the Canadian Cerebral Palsy Registry. One hundred eighty-two infants were born before 27 weeks of gestation, 461 infants were born between 27 and 33 weeks, and 325 infants were born between 34 and 37 weeks. Univariate and chi-square analyses were conducted to measure the association between early objective biomarkers and later mobility status defined as Gross Motor Function Classification System (GMFCS) levels IV and V as well as tube feeding dependence.

Results

Univariate analysis suggested no significant association between GMFCS levels IV and V or impaired feeding status and bilateral white matter injury on magnetic resonance imaging, high-grade intraventricular hemorrhage on head ultrasound, chorioamnionitis, a birth weight of 1000 to 1500 g or <1000 g, as well as an Apgar score of ≤5 at five minutes of life. Similar results were found for gestational age <28 weeks at birth. Only a significant association between GMFCS levels IV and V and a cord or first hour of life pH of ≤7 was reported (mobility status: odds ratio [OR] 1.95, 95% confidence interval [CI] 1.09 to 3.57) and feeding status: OR 2.23, CI 0.97 to 4.65)].

Conclusions

Prediction of functional outcomes based on specific early biomarkers appears hard to obtain in children with CP born preterm in contrast to those born at term. The complications and causal pathways inherent to prematurity may contribute to making prognostication less determinant.

预测早产脑瘫儿童日后功能障碍的早期生物标志物
方法从加拿大脑瘫登记处提取了968名早产儿的数据。其中 182 名婴儿在妊娠 27 周前出生,461 名婴儿在妊娠 27 至 33 周间出生,325 名婴儿在妊娠 34 至 37 周间出生。研究人员进行了单变量和卡方分析,以衡量早期客观生物标记物与日后行动能力状况(即粗大运动功能分类系统(GMFCS)IV级和V级)以及管喂依赖性之间的关联。结果二元分析表明,GMFCS IV级和V级或喂养状态受损与磁共振成像双侧白质损伤、头部超声高位脑室内出血、绒毛膜羊膜炎、出生体重1000克至1500克或1000克以及出生5分钟时Apgar评分≤5分之间无明显关联。出生时胎龄为 28 周的婴儿也有类似的结果。只有报告显示,GMFCS IV级和V级与脐带pH值或出生后第一小时pH值≤7之间存在明显关联(行动能力状况:几率比[OR]1.95,95%置信区间[CI]1.09至3.57)和喂养状况:结论与足月出生的早产儿相比,根据特定的早期生物标志物对早产儿 CP 儿童的功能结果进行预测似乎很难。早产儿固有的并发症和致病途径可能导致预后的决定性降低。
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来源期刊
Pediatric neurology
Pediatric neurology 医学-临床神经学
CiteScore
4.80
自引率
2.60%
发文量
176
审稿时长
78 days
期刊介绍: Pediatric Neurology publishes timely peer-reviewed clinical and research articles covering all aspects of the developing nervous system. Pediatric Neurology features up-to-the-minute publication of the latest advances in the diagnosis, management, and treatment of pediatric neurologic disorders. The journal''s editor, E. Steve Roach, in conjunction with the team of Associate Editors, heads an internationally recognized editorial board, ensuring the most authoritative and extensive coverage of the field. Among the topics covered are: epilepsy, mitochondrial diseases, congenital malformations, chromosomopathies, peripheral neuropathies, perinatal and childhood stroke, cerebral palsy, as well as other diseases affecting the developing nervous system.
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