Long-term neurodevelopmental outcomes in extremely preterm infants born at 22-26 weeks gestation: a follow-up of 2-2.5 years across two Swedish national cohorts from 2004-2007 to 2014-2016.
Ulrika Ådén, Aijaz Farooqi, Lena Hellstrom-Westas, Karin Sävman, Thomas Abrahamsson, Lars J Björklund, Magnus Domellöf, Anders Elfvin, Fredrik Ingemansson, Fredrik Serenius, Stellan Hakansson, David Ley, Erik Normann, Petra Um Bergström, Karin Kallen, Mikael Norman
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引用次数: 0
Abstract
Objective: To compare neurodevelopmental outcomes in extremely preterm (EPT) children born across two epochs in Sweden.
Design and setting: Nationwide population-based cohorts of infants born at 22-26 weeks' gestation in 2004-2007 (Cohort 1) and 2014-2016 (Cohort 2), comprising 1606 live births. Survivors were assessed at 2-2.5 years' corrected age using the same protocol design.
Main outcome: The primary outcome was neurodevelopmental impairment (NDI), defined as a composite of moderate-severe cerebral palsy (CP), visual or hearing deficits, or moderate-severe cognitive, language or motor impairment assessed with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley III). For children not assessed with Bayley-III, NDI was defined as moderate-severe speech delay, general developmental delay or categories of CP, vision and hearing impairment. Outcomes were compared using logistic regression to evaluate differences between cohorts and perinatal and socioeconomic risk factors.
Results: Of 1188 eligible survivors, 1062 (89.3%) were assessed (mean gestational age (GA) 24.8 weeks; 54.9% male). The prevalence of moderate-severe NDI at 22, 23, 24, 25 and 26 weeks' gestation was 60% vs 52%, 51% vs 51%, 34% vs 42%, 27% vs 32% and 17% vs 24% in Cohorts 1 and 2, respectively. Overall prevalence did not differ significantly (27% vs 35%; adjusted OR (AOR) 1.2, 95% CI 0.94 to 1.6). Among 724 (68%) children assessed with Bayley III, Cohort 2 had higher rates of cognitive delay (21.6% vs 11.3%; AOR 1.8, 95% CI 1.1 to 3.4) and language delay (40.9% vs 16.1%; AOR 3.3, 95% CI 1.4 to 4.1). Low GA and maternal country of birth outside the Nordic region were the strongest predictors of NDI and cognitive delay, the latter association confined to Cohort 2.
Conclusion: Although survival of EPT infants in Sweden has improved, long-term neurodevelopmental outcomes have not. The root causes of failed improvements in long-term outcomes for EPT infants are complex and need further clarification.
目的：比较瑞典两个时期出生的极早产儿（EPT）的神经发育结局。设计和背景：2004-2007年（队列1）和2014-2016年（队列2）期间出生在22-26周妊娠期的全国人群队列，包括1606例活产婴儿。使用相同的方案设计，在2-2.5岁的校正年龄对幸存者进行评估。主要转归：主要转归为神经发育障碍（NDI），定义为中重度脑瘫（CP）、视觉或听力缺陷、或中重度认知、语言或运动障碍的复合，采用Bayley婴幼儿发育量表第三版（Bayley III）进行评估。对于未进行Bayley-III评估的儿童，NDI被定义为中度至重度语言迟缓、一般发育迟缓或CP、视力和听力障碍类别。使用逻辑回归对结果进行比较，以评估队列、围产期和社会经济风险因素之间的差异。结果：在1188名符合条件的幸存者中，评估了1062名（89.3%）(平均胎龄（GA） 24.8周；54.9%的男性)。在第1组和第2组中，妊娠22、23、24、25和26周的中重度NDI患病率分别为60%对52%、51%对51%、34%对42%、27%对32%和17%对24%。总体患病率无显著差异（27% vs 35%；调整OR (AOR) 1.2, 95% CI 0.94 ~ 1.6）。在接受Bayley III评估的724名（68%）儿童中，队列2有更高的认知延迟率（21.6%对11.3%；AOR为1.8,95% CI 1.1至3.4）和语言延迟率（40.9%对16.1%；AOR为3.3,95% CI 1.4至4.1）。低GA和北欧地区以外的母国出生是NDI和认知延迟的最强预测因子，后者的关联仅限于队列2。结论：尽管瑞典EPT患儿的生存率有所提高，但长期的神经发育结局却没有改善。EPT患儿长期预后改善失败的根本原因是复杂的，需要进一步澄清。
期刊介绍：
Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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