Background: A previous randomised trial of continuous negative extrathoracic pressure (CNEP) versus standard treatment for newborn infants with respiratory distress syndrome raised public concerns about mortality and ...Background: A previous randomised trial of continuous negative extrathoracic pressure (CNEP) versus standard treatment for newborn infants with respiratory distress syndrome raised public concerns about mortality and neonatal morbidity. We studied the outcome in late childhood of children entered into the trial to establish whether there were long- term sequelae attributable to either mode of ventilation. Methods: Outpatient assessment of neurological outcome, cognitive function, and disability was done by a paediatrician and a psychologist using standardised tests. 133 of 205 survivors from the original trial were assessed at 9- 15 years of age. Of the original pairs randomly assigned to each ventilation mode, the results from 65 complete pairs were available. The primary outcome was death or severe disability. Findings: Primary outcome was equally distributed between groups (odds ratio for the CNEP group 1.0; 95% CI 0.41- 2.41). In unpaired analysis there was no significant difference between treatment modalities (1.05; 0.54- 2.06). Full IQ did not differ significantly between the groups, but mean performance IQ was 6.8 points higher in the CNEP group than in the conventional- treatment group (95% CI 1.5- 12.1)- . Results of neuropsychological testing were consistent with this finding, with scores on language production and visuospatial skills being significantly higher in the CNEP group. Interpretation: We saw no evidence of poorer longterm outcome after neonatal CNEP whether analysis was by original pairing or by unpaired comparisons, despite small differences in adverse neonatal outcomes. The experience of our study indicates that future studies of neonatal interventions with the potential to influence later morbidity should be designed with longer- term outcomes in mind.展开更多
Aims: To describe perinatal factors associated with later morbidity among ext remely preterm children at 30 months of age corrected for prematurity. Populatio n: Of 308 surviving children born at ≤ 25 weeks gestation...Aims: To describe perinatal factors associated with later morbidity among ext remely preterm children at 30 months of age corrected for prematurity. Populatio n: Of 308 surviving children born at ≤ 25 weeks gestation in the United Kingdom and Ireland from March to December 1995, 283 (92% ) were evaluated at 30 month s of age corrected for prematurity. Methods: Cerebral palsy, severe motor disabi lity, and Bayley scores were used as dependent variables in sequential multiple regression analyses to identify factors associated with adverse outcomes. Result s: Adverse outcomes were consistently more common in boys. Factors related to pe rinatal illness, ultrasound evidence of brain injury, and treatment (particularl y postnatal steroids)- were associated with adverse motor outcomes (cerebral pa lsy, disability or Bayley psychomotor development index). Increasing duration of postnatal steroid treatment was associated with poor motor outcomes. A score wa s developed for severe motor disability with good negative predictive value. In contrast,mental development was associated with a broader range of factors: ethn ic group, maternal educational level, the use of antenatal steroids, and prolong ed rupture of membranes in addition to chronic lung disease. Conclusion: Male se x is a pervasive risk factor for poor outcome at extremely low gestations. Avoid able or effective treatment factors are identified, which may indicate the poten tial for improving outcome.展开更多
Background: A previous randomised trial of continuous negative extrathoracic pressure (CNEP) versus standard treatment for newborn infants with respiratory distress syndrome raised public concerns about mortality and ...Background: A previous randomised trial of continuous negative extrathoracic pressure (CNEP) versus standard treatment for newborn infants with respiratory distress syndrome raised public concerns about mortality and neonatal morbidity. We studied the outcome in late childhood of children entered into the trial to establish whether there were long-term sequelae attributable to either mode of ventilation. Methods: Outpatient assessment of neurological outcome, cognitive function, and disability was done by a paediatrician and a psychologist using standardised tests. 133 of 205 survivors from the original trial were assessed at 9-15 years of age. Of the original pairs randomly assigned to each ventilation mode, the results from 65 complete pairs were available. The primary outcome was death or severe disability. Findings: Primary outcome was equally distributed between groups (odds ratio for the CNEP group 1.0; 95%CI 0.41-2.41). In unpaired analysis there was no significant difference between treatment modalities (1.05; 0.54-2.06). Full IQ did not differ significantly between the groups, but mean performance IQ was 6.8 points higher in the CNEP group than in the conventional-treatment group (95%CI 1.5-12.1). Results of neuropsychological testing were consistent with this finding, with scores on language production and visuospatial skills being significantly higher in the CNEP group. Interpretation: We saw no evidence of poorer longterm outcome after neonatal CNEP whether analysis was by original pairing or by unpaired comparisons, despite small differences in adverse neonatal outcomes. The experience of our study indicates that future studies of neonatal interventions with the potential to influence later morbidity should be designed with longer-term outcomes in mind.展开更多
文摘Background: A previous randomised trial of continuous negative extrathoracic pressure (CNEP) versus standard treatment for newborn infants with respiratory distress syndrome raised public concerns about mortality and neonatal morbidity. We studied the outcome in late childhood of children entered into the trial to establish whether there were long- term sequelae attributable to either mode of ventilation. Methods: Outpatient assessment of neurological outcome, cognitive function, and disability was done by a paediatrician and a psychologist using standardised tests. 133 of 205 survivors from the original trial were assessed at 9- 15 years of age. Of the original pairs randomly assigned to each ventilation mode, the results from 65 complete pairs were available. The primary outcome was death or severe disability. Findings: Primary outcome was equally distributed between groups (odds ratio for the CNEP group 1.0; 95% CI 0.41- 2.41). In unpaired analysis there was no significant difference between treatment modalities (1.05; 0.54- 2.06). Full IQ did not differ significantly between the groups, but mean performance IQ was 6.8 points higher in the CNEP group than in the conventional- treatment group (95% CI 1.5- 12.1)- . Results of neuropsychological testing were consistent with this finding, with scores on language production and visuospatial skills being significantly higher in the CNEP group. Interpretation: We saw no evidence of poorer longterm outcome after neonatal CNEP whether analysis was by original pairing or by unpaired comparisons, despite small differences in adverse neonatal outcomes. The experience of our study indicates that future studies of neonatal interventions with the potential to influence later morbidity should be designed with longer- term outcomes in mind.
文摘Aims: To describe perinatal factors associated with later morbidity among ext remely preterm children at 30 months of age corrected for prematurity. Populatio n: Of 308 surviving children born at ≤ 25 weeks gestation in the United Kingdom and Ireland from March to December 1995, 283 (92% ) were evaluated at 30 month s of age corrected for prematurity. Methods: Cerebral palsy, severe motor disabi lity, and Bayley scores were used as dependent variables in sequential multiple regression analyses to identify factors associated with adverse outcomes. Result s: Adverse outcomes were consistently more common in boys. Factors related to pe rinatal illness, ultrasound evidence of brain injury, and treatment (particularl y postnatal steroids)- were associated with adverse motor outcomes (cerebral pa lsy, disability or Bayley psychomotor development index). Increasing duration of postnatal steroid treatment was associated with poor motor outcomes. A score wa s developed for severe motor disability with good negative predictive value. In contrast,mental development was associated with a broader range of factors: ethn ic group, maternal educational level, the use of antenatal steroids, and prolong ed rupture of membranes in addition to chronic lung disease. Conclusion: Male se x is a pervasive risk factor for poor outcome at extremely low gestations. Avoid able or effective treatment factors are identified, which may indicate the poten tial for improving outcome.
文摘Background: A previous randomised trial of continuous negative extrathoracic pressure (CNEP) versus standard treatment for newborn infants with respiratory distress syndrome raised public concerns about mortality and neonatal morbidity. We studied the outcome in late childhood of children entered into the trial to establish whether there were long-term sequelae attributable to either mode of ventilation. Methods: Outpatient assessment of neurological outcome, cognitive function, and disability was done by a paediatrician and a psychologist using standardised tests. 133 of 205 survivors from the original trial were assessed at 9-15 years of age. Of the original pairs randomly assigned to each ventilation mode, the results from 65 complete pairs were available. The primary outcome was death or severe disability. Findings: Primary outcome was equally distributed between groups (odds ratio for the CNEP group 1.0; 95%CI 0.41-2.41). In unpaired analysis there was no significant difference between treatment modalities (1.05; 0.54-2.06). Full IQ did not differ significantly between the groups, but mean performance IQ was 6.8 points higher in the CNEP group than in the conventional-treatment group (95%CI 1.5-12.1). Results of neuropsychological testing were consistent with this finding, with scores on language production and visuospatial skills being significantly higher in the CNEP group. Interpretation: We saw no evidence of poorer longterm outcome after neonatal CNEP whether analysis was by original pairing or by unpaired comparisons, despite small differences in adverse neonatal outcomes. The experience of our study indicates that future studies of neonatal interventions with the potential to influence later morbidity should be designed with longer-term outcomes in mind.
