Journal of Shanghai Jiao Tong University (Medical Science) >

2023 , Vol. 43 >Issue 4: 445 - 452

DOI: https://doi.org/10.3969/j.issn.1674-8115.2023.04.006

Clinical research

Current status of neurodevelopmental outcomes and its influencing factors of early-to-moderate preterm infants at corrected age of 18 months

  • Li SHEN ,
  • Hengye HUANG ,
  • Guangjun YU
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  • 1.Shanghai Jiao Tong University School of Public Health, Shanghai 200025, China
    2.Clinical Research Center, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
    3.Children's Precision Medicine Engineering Technology Research Center, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200040, China
YU Guangjun, E-mail: gjyu@shchildren.com.cn.
HUANG Hengye, E-mail: hengyehuang@sjtu.edu.cn

Received date: 2022-11-12

  Accepted date: 2023-03-14

  Online published: 2023-04-28

Supported by

Clinical Research Plan of Shanghai Hospital Development Center for Multi-Center Clinical Research of Major Diseases(SHDC2020CR1047B)

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Abstract

Objective ·To analyze the neurodevelopmental outcomes and risk factors of early-to-moderate preterm infants with gestational age≤34 weeks at corrected age of 18 months. Methods ·The early-to-moderate preterm infants hospitalized in Neonatal Intensive Care Unit of Shanghai Children's Hospital from January 2013 to April 2020, and regularly followed up after discharge were included in this study. Demographic and clinically relevant data of preterm infants and their parents were collected. The infants were divided into the neurodevelopmental retardation group and the normal neurodevelopment group according to their Gesell Development Schedule (GDS) scores at corrected age of 18 months. The demographic characteristics of preterm infants, birth status, demographic characteristics of parents and prenatal examinations between the two groups were compared, and stepwise Logistic regression was used to explore the factors influencing neurodevelopmental outcomes in preterm infants. Results ·A total of 929 preterm infants were included in the study, including 527 boys (56.7%) and 402 girls (43.3%), with a mean gestational age of (31.06±2.23) weeks and 138 (14.9%) extremely preterm infants. A total of 147 infants (15.8%) had neurodevelopmental retardation of early-to-moderate preterm infants at corrected age of 18 months, with abnormalities of 7.4%, 9.7%, 17.9%, 14.2% and 13.7% in gross motor, fine motor, language, adaptive behavior and personal-social behavior, respectively. A comparison of the clinical characteristics between the neurodevelopmental retardation group and the normal neurodevelopment group revealed statistically significant differences in terms of gender, whether the baby was an extremely preterm infant, birth weight, mode of delivery, and occurrence of intrauterine distress (all P<0.05). Stepwise Logistic regression analysis showed that boys (OR=1.60, 95%CI 1.05?2.44, P=0.028), cesarean section (OR=1.67, 95%CI 1.08?2.60, P=0.022), extremely preterm infants (OR=2.20, 95%CI 1.34?3.62, P=0.002) and intrauterine distress (OR=5.03, 95%CI 2.11?11.99, P=0.000) were the risk factors for neurodevelopmental retardation. Conclusion ·Boys, extremely preterm infants, cesarean section and intrauterine distress may increase the neurodevelopmental retardation risk of early-to-moderate preterm infants and improving follow-up management of these preterm infants should be focused on and enhanced.

Key words： preterm infant; neurodevelopment; neurodevelopmental retardation; risk factor; Gesell Development Schedule

Cite this article

Li SHEN , Hengye HUANG , Guangjun YU . Current status of neurodevelopmental outcomes and its influencing factors of early-to-moderate preterm infants at corrected age of 18 months[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023 , 43(4) : 445 -452 . DOI: 10.3969/j.issn.1674-8115.2023.04.006

References

1 PIERRAT V, MARCHAND-MARTIN L, MARRET S, et al. Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study[J]. BMJ, 2021, 373: n741.
2 王华倩, 姚宝珍. 早产儿神经发育特点及临床诊疗进展[J]. 中国儿童保健杂志, 2021, 29(8): 877-880
2 WANG H Q, YAO B Z. Progress of neurodevelopmental characteristics and clinical diagnosis and treatment in premature infants[J]. Chinese Journal of Child Health Care, 2021, 29(8): 877-880.
3 FERNáNDEZ DE GAMARRA-OCA L, OJEDA N, GóMEZ-GASTIASORO A, et al. Long-term neurodevelopmental outcomes after moderate and late preterm birth: a systematic review[J]. J Pediatr, 2021, 237: 168-176.e11.
4 张丽君, 王彦林. 198例早中期早产临床资料分析[J]. 上海交通大学学报(医学版), 2007, 27(7): 850-852.
4 ZHANG L J, WANG Y L. Clinical analysis of 198 cases of early-to-moderate preterm birth[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2007, 27(7): 850-852.
5 BAUD O, TROUSSON C, BIRAN V, et al. Association between early low-dose hydrocortisone therapy in extremely preterm neonates and neurodevelopmental outcomes at 2 years of age[J]. JAMA, 2017, 317(13): 1329-1337.
6 沈力, 田园, 于广军, 等. 上海市高危儿神经发育情况及其影响因素分析[J]. 中国儿童保健杂志, 2019, 27(4): 366-369.
6 SHEN L, TIAN Y, YU G J, et al. Analysis of the neurodevelopment and its influencing factors of high-risk infants in Shanghai[J]. Chinese Journal of Child Health Care, 2019, 27(4): 366-369.
7 CHAWLA S, NATARAJAN G, SHANKARAN S, et al. Association of neurodevelopmental outcomes and neonatal morbidities of extremely premature infants with differential exposure to antenatal steroids[J]. JAMA Pediatr, 2016, 170(12): 1164-1172.
8 徐姗姗, 黄红, 张劲松. 婴幼儿诊断性发育量表研究及应用进展[J]. 中国儿童保健杂志, 2010, 18(11): 859-861.
8 XU S S, HUANG H, ZHANG J S. Progress in the study and application of diagnostic developmental scales for infants and toddlers[J]. Chinese Journal of Child Health Care, 2010, 18(11): 859-861.
9 《中华儿科杂志》编辑委员会, 中华医学会儿科学分会新生儿学组. 早产儿管理指南[J]. 中华儿科杂志, 2006, 44(3): 188-191.
9 The Editorial Board of Chinese Journal of Pediatrics, The Group of Neonatology, Society of Pediatrics, Chinese Medical Association. Guidelines for management of premature infants[J]. Chinese Journal of Pediatrics, 2006, 44(3): 188-191.
10 NINAN K, LIYANAGE S K, MURPHY K E, et al. Evaluation of long-term outcomes associated with preterm exposure to antenatal corticosteroids: a systematic review and meta-analysis[J]. JAMA Pediatr, 2022, 176(6): e220483.
11 黄海燕. 早产儿神经系统发育结局的研究进展[J]. 中国儿童保健杂志, 2016, 24(2): 153-155
11 HUANG H Y. Progress in the study of neurological developmental outcomes in preterm infants[J]. Chinese Journal of Child Health Care, 2016, 24(2): 153-155.
12 BLENCOWE H, LEE A C, COUSENS S, et al. Preterm birth-associated neurodevelopmental impairment estimates at regional and global levels for 2010[J]. Pediatr Res, 2013, 74(Suppl 1): 17-34.
13 黄小娜, 张悦, 冯围围, 等. 儿童心理行为发育问题预警征象筛查表的信度效度评估[J]. 中华儿科杂志, 2017, 55(6): 445-450.
13 HUANG X N, ZHANG Y, FENG W W, et al. Reliability and validity of warning signs checklist for screening psychological, behavioral and developmental problems of children[J]. Chinese Journal of Pediatrics, 2017, 55(6): 445-450.
14 CHENG J, LI J, TANG X. Analysis of perinatal risk factors for small-for-gestational-age and appropriate-for-gestational-age late-term infants[J]. Exp Ther Med, 2020, 19(3): 1719-1724.
15 SANTOS S, FERREIRA H, MARTINS J, et al. Male sex bias in early and late onset neurodevelopmental disorders: shared aspects and differences in autism spectrum disorder, attention deficit/hyperactivity disorder, and schizophrenia[J]. Neurosci Biobehav Rev, 2022, 135: 104577.
16 DI ROSA G, PIRONTI E, CUCINOTTA F, et al. Gender affects early psychomotor milestones and long-term neurodevelopment of preterm infants[J]. Inf Child Dev, 2019, 28(1): e2110.
17 KNICKMEYER R C, WANG J P, ZHU H T, et al. Impact of sex and gonadal steroids on neonatal brain structure[J]. Cereb Cortex, 2014, 24(10): 2721-2731.
18 BREACH M R, LENZ K M. Sex differences in neurodevelopmental disorders: a key role for the immune system[J]. Curr Top Behav Neurosci, 2023, 62: 165-206.
19 PLATT M J, CANS C, JOHNSON A, et al. Trends in cerebral palsy among infants of very low birthweight (<1 500 g) or born prematurely (<32 weeks) in 16 European centres: a database study[J]. Lancet, 2007, 369(9555): 43-50.
20 CHEONG J L, DOYLE L W, BURNETT A C, et al. Association between moderate and late preterm birth and neurodevelopment and social-emotional development at age 2 years[J]. JAMA Pediatr, 2017, 171(4): e164805.
21 周凤娟, 屠思, 刘贤, 等. 不同出生胎龄早产儿的智能发育水平分析[J]. 中国儿童保健杂志, 2019, 27(4): 429-432.
21 ZHOU F J, TU S, LIU X, et al. Study on the development of intelligence in preterm infants with different gestational ages[J]. Chinese Journal of Child Health Care, 2019, 27(4): 429-432.
22 李蓓, 冯菁菁, 徐秀. 早产儿早期神经运动发育纵向随访[J]. 中国儿童保健杂志, 2013, 21(5): 470-472, 476.
22 LI B, FENG J J, XU X. Follow-up study on early neurodevelopment of preterm children[J]. Chinese Journal of Child Health Care, 2013, 21(5): 470-472, 476.
23 BIOSCA M, RODRíGUEZ G, VENTURA P, et al. Central adiposity in children born small and large for gestational age[J]. Nutr Hosp, 2011, 26(5): 971-976.
24 BELL E F, HINTZ S R, HANSEN N I, et al. Mortality, in-hospital morbidity, care practices, and 2-year outcomes for extremely preterm infants in the US, 2013?2018[J]. JAMA, 2022, 327(3): 248-263.
25 CHAN E, LEONG P, MALOUF R, et al. Long-term cognitive and school outcomes of late-preterm and early-term births: a systematic review[J]. Child Care Health Dev, 2016, 42(3): 297-312.
26 BOERMA T, RONSMANS C, MELESSE D Y, et al. Global epidemiology of use of and disparities in caesarean sections[J]. Lancet, 2018, 392(10155): 1341-1348.
27 KUHLE S, TONG O S, WOOLCOTT C G. Association between caesarean section and childhood obesity: a systematic review and meta-analysis[J]. Obes Rev, 2015, 16(4): 295-303.
28 赵艳君, 陈倩, 刘含, 等. 分娩方式对儿童神经精神发育影响的出生队列研究[J]. 临床儿科杂志, 2021, 39(7): 501-505.
28 ZHAO Y J, CHEN Q, LIU H, et al. The association between mode of delivery and neuropsychological development of children: a birth cohort study[J]. Journal of Clinical Pediatrics, 2021, 39(7): 501-505.
29 ZHANG T Y, SIDORCHUK A, SEVILLA-CERME?O L, et al. Association of cesarean delivery with risk of neurodevelopmental and psychiatric disorders in the offspring: a systematic review and meta-analysis[J]. JAMA Netw Open, 2019, 2(8): e1910236.
30 SANDALL J, TRIBE R M, AVERY L, et al. Short-term and long-term effects of caesarean section on the health of women and children[J]. Lancet, 2018, 392(10155): 1349-1357.
31 POLIDANO C, ZHU A N, BORNSTEIN J C. The relation between cesarean birth and child cognitive development[J]. Sci Rep, 2017, 7: 11483.
32 BELLONO N W, BAYRER J R, LEITCH D B, et al. Enterochromaffin cells are gut chemosensors that couple to sensory neural pathways[J]. Cell, 2017, 170(1): 185-198.e16.
33 DIGAL K C, SINGH P, SRIVASTAVA Y, et al. Effects of delayed cord clamping in intrauterine growth-restricted neonates: a randomized controlled trial[J]. Eur J Pediatr, 2021, 180(6): 1701-1710.
34 LI S J, LIU W, WANG J L, et al. The role of TNF-α, IL-6, IL-10, and GDNF in neuronal apoptosis in neonatal rat with hypoxic-ischemic encephalopathy[J]. Eur Rev Med Pharmacol Sci, 2014, 18(6): 905-909.
35 LI T, LUO Z Q, LIU Y, et al. Excessive activation of NMDA receptors induced neurodevelopmental brain damage and cognitive deficits in rats exposed to intrauterine hypoxia[J]. Neurochem Res, 2018, 43(3): 566-580.
36 李晓庆, 黄达, 王瑞泉, 等. 胎儿宫内窘迫及新生儿轻度窒息对婴儿早期神经系统发育和体格的影响[J]. 福建医药杂志, 2018, 40(6): 49-52.
36 LIU X Q, HUANG D, WANG R Q, et al. Effects of intrauterine distress and mild neonatal asphyxia on early neurological development and physical fitness of infants[J]. Fujian Medical Journal, 2018, 40(6): 49-52.
37 刘正艳. 高压氧疗法对新生儿缺氧缺血性脑病患儿行为神经功能和智能发育的影响[J]. 中国实用神经疾病杂志, 2017, 20(4): 98-100.
37 LIU Z Y. Effect of hyperbaric oxygen therapy on behavioral neurological function and intellectual development in children with neonatal hypoxic-ischemic encephalopathy[J]. Chinese Journal of Practical Nervous Diseases, 2017, 20(4): 98-100.
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