Context: Neonatal infections are frequent complications of extremely low- birth- weight (ELBW) infants receiving intensive care. Objective: To determine if neonatal infections in ELBW infants are associated with incre...Context: Neonatal infections are frequent complications of extremely low- birth- weight (ELBW) infants receiving intensive care. Objective: To determine if neonatal infections in ELBW infants are associated with increased risks of adverse neurodevelopmental and growth sequelae in early childhood. Design, Setting, and Participants: Infants weighing 401 to 1000 g at birth (born in 1993- 2001) were enrolled in a prospectively collected very low- birth- weight registry at academic medical centers participating in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth outcomes were assessed at a comprehensive follow- up visit at 18 to 22 months of corrected gestational age and compared by infection group. Eighty percent of survivors completed the follow- up visit and 6093 infants were studied. Registry data were used to classify infants by type of infection: uninfected (n=2161), clinical infection alone (n=1538), sepsis (n=1922), sepsis and necrotizing enterocolitis (n=279), or meningitis with or without sepsis (n=193). Main Outcome Measures: Cognitive and neuromotor development, neurologic status, vision and hearing, and growth (weight, length, and head circumference) were assessed at follow- up. Results: The majority of ELBW survivors (65% ) had at least 1 infection during their hospitalization after birth. Compared with uninfected infants, those in each of the 4 infection groups were significantly more likely to have adverse neurodevelopmental outcomes at follow- up, including cerebral palsy (range of significant odds ratios [ORs], 1.4- 1.7), low Bayley Scales of Infant Development II scores on the mental development index (ORs, 1.3- 1.6)- and psychomotor development index (ORs, 1.5- 2.4), and vision impairment (ORs, 1.3- 2.2). Infection in the neonatal period was also associated with impaired head growth, a known predictor of poor neurodevelopmental outcome. Conclusions: This large cohort study suggests that neonatal infections among ELBW infants are associated with poor neurodevelopmental and growth outcomes in early childhood. Additional studies are needed to elucidate the pathogenesis of brain injury in infants with infection so that novel interventions to improve these outcomes can be explored.展开更多
目的探讨合并脑损伤高危因素的小于胎龄儿的早期运动发育特点。方法回顾性纳入2022年2~10月在西安市儿童医院新生儿随访门诊随访,合并脑损伤高危因素且在校正年龄(corrected age,CA)2~5周或CA14~17周随访并完成一次婴儿运动能力测试(Tes...目的探讨合并脑损伤高危因素的小于胎龄儿的早期运动发育特点。方法回顾性纳入2022年2~10月在西安市儿童医院新生儿随访门诊随访,合并脑损伤高危因素且在校正年龄(corrected age,CA)2~5周或CA14~17周随访并完成一次婴儿运动能力测试(Test of Infant Motor Performanc,TIMP)的小于胎龄儿(small for gestational age,SGA)和适于胎龄儿(appropriate for gestational age,AGA)共81例。CA2~5周随访到SGA 17例(SGA组),AGA 24例(AGA组);CA14~17周随访到SGA 20例(SGA组),AGA 20例(AGA组)。采用两独立样本t检验、秩和检验及χ^(2)检验比较组间的人口学特征、脑损伤高危因素及TIMP各项评分的差异。结果CA2~5周和CA14~17周,SGA组的出生体重均低于AGA组[(1817.1±440.3)与(2630.0±560.9)g,t=-4.98;(1752.0±434.4)与(2226.3±699.8)g,t=-2.58;P值均<0.05],但2组的出生胎龄、脑损伤高危因素差异均无统计学意义(P值均>0.05)。(1)CA2~5周:SGA组TIMP原始总分[(71.6±13.7)与(80.5±11.5)分,t=-2.26,P=0.029]、引出项评分[61.0分(41.0~85.0分)与69.1分(49.0~96.0分),Z=-2.15,P=0.037]和坐位[8.8分(3.0~19.0分)与11.2分(5.0~22.0分),Z=-2.07,P=0.038]、俯卧位评分[(9.8±3.1)与(12.3±3.1)分,t=-2.19,P=0.034]均低于AGA组。(2)CA14~17周:SGA组患儿的TIMP站立位评分低于AGA组[6.5分(4.0~11.0分)与7.7分(2.0~11.0分),Z=-2.05,P=0.040],但原始总分及坐位、仰卧位、俯卧位、翻身、侧方位各体位评分组间差异均无统计学意义(P值均>0.05)。结论5月龄前,SGA的早期运动能力较AGA低,在CA2~5周主要表现为头控能力相对落后,在CA14~17周时头控能力落后延续至站立位。展开更多
目的观察早期综合干预婴儿运动发育迟缓的临床疗效。方法选取156例运动发育迟缓患儿,随机分为治疗组(79例)和对照组(77例),对照组仅采取运动训练,治疗组运用以推拿按摩及中医五行音乐疗法为主、配合运动训练的综合干预方法,疗程均为2月...目的观察早期综合干预婴儿运动发育迟缓的临床疗效。方法选取156例运动发育迟缓患儿,随机分为治疗组(79例)和对照组(77例),对照组仅采取运动训练,治疗组运用以推拿按摩及中医五行音乐疗法为主、配合运动训练的综合干预方法,疗程均为2月。干预前、后采用婴儿神经国际量表(Infant Neurological International Battery,INFANIB)对婴儿神经发育进行评估。结果干预前2组INFANIB评估结果均为境界,干预后对照组中63例达到正常,有效率为81.82%;治疗组78例达到正常,有效率为98.73%。2组有效率比较,差异有统计学意义(P<0.05)。结论以推拿按摩及中医五行音乐疗法为主的早期综合干预方法能显著提高运动发育迟缓患儿的运动功能,改善运动发育迟缓。展开更多
文摘Context: Neonatal infections are frequent complications of extremely low- birth- weight (ELBW) infants receiving intensive care. Objective: To determine if neonatal infections in ELBW infants are associated with increased risks of adverse neurodevelopmental and growth sequelae in early childhood. Design, Setting, and Participants: Infants weighing 401 to 1000 g at birth (born in 1993- 2001) were enrolled in a prospectively collected very low- birth- weight registry at academic medical centers participating in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth outcomes were assessed at a comprehensive follow- up visit at 18 to 22 months of corrected gestational age and compared by infection group. Eighty percent of survivors completed the follow- up visit and 6093 infants were studied. Registry data were used to classify infants by type of infection: uninfected (n=2161), clinical infection alone (n=1538), sepsis (n=1922), sepsis and necrotizing enterocolitis (n=279), or meningitis with or without sepsis (n=193). Main Outcome Measures: Cognitive and neuromotor development, neurologic status, vision and hearing, and growth (weight, length, and head circumference) were assessed at follow- up. Results: The majority of ELBW survivors (65% ) had at least 1 infection during their hospitalization after birth. Compared with uninfected infants, those in each of the 4 infection groups were significantly more likely to have adverse neurodevelopmental outcomes at follow- up, including cerebral palsy (range of significant odds ratios [ORs], 1.4- 1.7), low Bayley Scales of Infant Development II scores on the mental development index (ORs, 1.3- 1.6)- and psychomotor development index (ORs, 1.5- 2.4), and vision impairment (ORs, 1.3- 2.2). Infection in the neonatal period was also associated with impaired head growth, a known predictor of poor neurodevelopmental outcome. Conclusions: This large cohort study suggests that neonatal infections among ELBW infants are associated with poor neurodevelopmental and growth outcomes in early childhood. Additional studies are needed to elucidate the pathogenesis of brain injury in infants with infection so that novel interventions to improve these outcomes can be explored.
文摘目的探讨合并脑损伤高危因素的小于胎龄儿的早期运动发育特点。方法回顾性纳入2022年2~10月在西安市儿童医院新生儿随访门诊随访,合并脑损伤高危因素且在校正年龄(corrected age,CA)2~5周或CA14~17周随访并完成一次婴儿运动能力测试(Test of Infant Motor Performanc,TIMP)的小于胎龄儿(small for gestational age,SGA)和适于胎龄儿(appropriate for gestational age,AGA)共81例。CA2~5周随访到SGA 17例(SGA组),AGA 24例(AGA组);CA14~17周随访到SGA 20例(SGA组),AGA 20例(AGA组)。采用两独立样本t检验、秩和检验及χ^(2)检验比较组间的人口学特征、脑损伤高危因素及TIMP各项评分的差异。结果CA2~5周和CA14~17周,SGA组的出生体重均低于AGA组[(1817.1±440.3)与(2630.0±560.9)g,t=-4.98;(1752.0±434.4)与(2226.3±699.8)g,t=-2.58;P值均<0.05],但2组的出生胎龄、脑损伤高危因素差异均无统计学意义(P值均>0.05)。(1)CA2~5周:SGA组TIMP原始总分[(71.6±13.7)与(80.5±11.5)分,t=-2.26,P=0.029]、引出项评分[61.0分(41.0~85.0分)与69.1分(49.0~96.0分),Z=-2.15,P=0.037]和坐位[8.8分(3.0~19.0分)与11.2分(5.0~22.0分),Z=-2.07,P=0.038]、俯卧位评分[(9.8±3.1)与(12.3±3.1)分,t=-2.19,P=0.034]均低于AGA组。(2)CA14~17周:SGA组患儿的TIMP站立位评分低于AGA组[6.5分(4.0~11.0分)与7.7分(2.0~11.0分),Z=-2.05,P=0.040],但原始总分及坐位、仰卧位、俯卧位、翻身、侧方位各体位评分组间差异均无统计学意义(P值均>0.05)。结论5月龄前,SGA的早期运动能力较AGA低,在CA2~5周主要表现为头控能力相对落后,在CA14~17周时头控能力落后延续至站立位。
文摘目的观察早期综合干预婴儿运动发育迟缓的临床疗效。方法选取156例运动发育迟缓患儿,随机分为治疗组(79例)和对照组(77例),对照组仅采取运动训练,治疗组运用以推拿按摩及中医五行音乐疗法为主、配合运动训练的综合干预方法,疗程均为2月。干预前、后采用婴儿神经国际量表(Infant Neurological International Battery,INFANIB)对婴儿神经发育进行评估。结果干预前2组INFANIB评估结果均为境界,干预后对照组中63例达到正常,有效率为81.82%;治疗组78例达到正常,有效率为98.73%。2组有效率比较,差异有统计学意义(P<0.05)。结论以推拿按摩及中医五行音乐疗法为主的早期综合干预方法能显著提高运动发育迟缓患儿的运动功能,改善运动发育迟缓。
