Comparison of the Bayley II Mental Developmental Index and the Bayley III cognitive scale: are we measuring the same thing?

Aim: To better understand differences between Bayley Scales 3rd edition (Bayley III) Cognitive Scale and Bayley Scales 2nd edition (Bayley II) Mental Developmental Index (MDI) in 18–22‐month‐old children born term and preterm and to create a conversion algorithm using Bayley II MDI to calculate Bayley III Cognitive score. Methods: This study included 51 term and 26 preterm children between 18 and 22 months, ages adjusted for prematurity. Children’s scores on Bayley II MDI and Bayley III Cognitive Scale were compared using t‐tests. The items from Bayley II MDI were used to calculate a score for the Bayley III Cognitive Scale. ANCOVA was used to create a conversion scale. Results: Bayley III Cognitive scores were significantly higher than Bayley II MDI scores for term and preterm toddlers combined and separately (p < .0001). A conversion formula to convert Bayley II MDI to a Bayley III Cognitive score was calculated. Conclusion: Term and preterm children had similarly elevated scores on the Bayley III calculated Cognitive score compared to the previous Bayley II MDI score. The use of a conversion algorithm may be helpful in studies that used both Bayley editions to get comparable outcome measurements within a clinical or research paradigm.     

早中期早产儿神经发育不良相关的感染因素分析

目的 探讨与早中期早产儿在校正18月龄时神经发育不良相关的感染因素。方法 以2015年6月至2018年12月入住新生儿重症监护病房并在早产高危儿门诊随访的胎龄28~ < 34周早产儿为研究对象。校正18月龄时采用修订版Bayley婴幼儿发展量表进行神经发育评估,运用单因素和多因素logistic回归分析探讨对神经发育产生影响的感染相关因素。结果 纳入早中期早产儿138例,其中校正18月龄时神经发育不良者59例。单因素logistic回归分析显示早中期早产儿神经发育不良与晚发感染、血培养阳性、其他系统感染有关（P < 0.05）;多因素logistic回归分析显示晚发感染是神经发育不良的独立危险因素（OR=1.510,95% CI：1.133~3.600,P < 0.05）。结论 晚发感染可增加早中期早产儿神经发育不良的风险。     

晚期早产儿和早期足月儿1岁时神经心理发育水平的随访研究

目的 探讨晚期早产儿和早期足月儿1岁时的神经心理发育水平。方法 选择矫正年龄为1岁的1 257名儿童为研究对象。根据其出生时胎龄分为4组：早期早产儿（胎龄28~33⁺⁶周）、晚期早产儿（胎龄34~36⁺⁶周）、早期足月儿（胎龄37~38⁺⁶周）及完全足月儿（胎龄39~41⁺⁶周）。采用Gesell发展量表评估其神经心理发育水平,比较各组儿童在1岁时神经心理发育状况。结果 4组儿童1岁时5大能区（适应性、大运动、精细动作、语言、个人社交）发育商的差异均有统计学意义（P < 0.05）,且均表现为完全足月儿 > 早期足月儿 > 晚期早产儿 > 早期早产儿的趋势（P < 0.05）;各能区发育迟缓率也均表现为完全足月儿最低,早期早产儿最高（P < 0.05）。与完全足月儿相比,早期足月儿适应能力发育落后的风险增加（OR=1.796,P < 0.05）;晚期早产儿适应能力和精细动作发育落后的风险较高,OR值分别为2.651、2.679（P < 0.05）;早期早产儿适应能力、精细动作和个人社交能力发育落后的风险较高,OR值分别为4.069、3.710、3.515（P < 0.05）。结论 儿童1岁时神经心理发育落后的风险随出生胎龄的增加而降低,呈现剂量反应效应。早期足月儿和晚期早产儿仍然存在不同程度的发育落后,应重视早期足月儿和晚期早产儿的保健随访。     

Hypothyroxinemia of prematurity and infant neurodevelopment: a pilot study

To assess whether hypothyroxinemia has specific effects on neurodevelopment in premature infants, thyroid hormone levels were determined at 2 weeks of life and 40 weeks postconceptional age (PCA), and infants were evaluated at 3 months corrected age using the Bayley Scales of Infant Development and Early Infancy Temperament Questionnaire. Additional attention scales were derived from the factor analysis of relevant Bayley items. Fifteen infants born between 30 and 35 weeks and 21 full-term infants were studied. Results indicated no group differences on the Bayley or derived attention scales, whereas the temperament questionnaire revealed lower sensory thresholds and greater reactivity in the preterm group. The preterm group had normal thyroxine (T4) levels at 2 weeks of age, which declined by 40 weeks PCA for both free T4 (p < .01 for reference value and p < .0001 for gestational age-adjusted value) and total T4 (p < .05 for age-adjusted value). Correlations revealed that higher 40-week PCA free T4 levels were associated with better attentiveness ratings (p < .01 for reference and p < .0001 for gestational-age values) and sustained attention (p < .05) and higher 40-week total T4 with better motor skills (p < .05 for gestational-age value). These findings signify that a mild degree of hypothyroxinemia is evident in preterm infants without neurological risk and predicts subsequently poorer cognitive and motor abilities.     

Prediction for developmental delay on Neonatal Oral Motor Assessment Scale in preterm infants without brain lesion

Background:  Preterm infants often have difficulty in achieving a coordinated sucking pattern. To analyze the correlation between preterm infants with disorganized sucking and future development, weekly studies were performed of 27 preterm infants from initiation of bottle feeding until a normal sucking pattern was recognized.
Methods:  A total of 27 preterm infants without brain lesion participated in the present study. Neonatal Oral Motor Assessment Scale (NOMAS) was utilized to evaluate the sucking pattern. Infants who were initially assessed as having disorganized sucking on NOMAS and regained a normal sucking pattern by 37 weeks old were assigned to group I; infants with a persistent disorganized sucking pattern after 37 weeks were assigned to group II. The mental (MDI) and psychomotor (PDI) developmental indices of Bayley Scales of Infant Development, second edition were used for follow-up tests to demonstrate neurodevelopment at 6 months and 12 months of corrected age.
Results:  At 6 months follow up, subjects in group I had a significantly higher PDI score than group II infants ( P = 0.04). At 12 months follow up, group I subjects had a significantly higher score on MDI ( P = 0.03) and PDI ( P = 0.04). There was also a higher rate for development delay in group II at 6 months ( P = 0.05).
Conclusion:  NOMAS-based assessment for neonatal feeding performance could be a helpful tool to predict neurodevelopmental outcome at 6 and 12 months. Close follow up and early intervention may be necessary for infants who present with a disorganized sucking pattern after 37 weeks post-conceptional age.     

晚期早产儿早期智能发育结局的研究

目的探讨晚期早产儿(LPI)早期智能发育结局。方法选择2012年1月至2015年1月新生儿病房收治的出生胎龄34~36+6周、治愈出院并定期规律随访的106例早产儿为晚期早产儿组;随机抽取同期120例健康足月儿(FPI)为对照组。对校正年龄40周的晚期早产儿及40周龄的足月儿进行新生儿神经行为测定(NBNA),晚期早产儿校正龄3、6、12月龄或者足月儿3、6、12月龄时采用Gesell发育量表进行评估。结果 LPI组NBNA评分低于37分,低于FTI组(P0.05)。校正龄3月龄时,LPI组大运动、精细运动、个人社交落后于FTI组(P0.05);校正龄6月龄时,LPI组适应性、大运动、精细运动落后于FTI组(P0.05);校正年龄12月龄时,LPI组适应性、大运动、个人社交测评明显低于FTI组(P0.05)。结论晚期早产儿早期智能发育迟缓,需加强神经发育监测。     

Health service utilisation of a regional cohort of very preterm infants over the first 2 years of life

AIM: Very preterm infants represent major consumers of health services following neonatal discharge. We examined the health service utilisation of a regional cohort of very preterm infants over the first 2 years of life, including the association with neurodevelopmental outcome. METHODS: A regionally based 2-year cohort of 100 very preterm infants along with a comparison sample of 104 full term control infants matched for sex, time and place of birth were recruited. Perinatal and social background factors that predispose very preterm infants to increased risk of subsequent general practitioner (GP) and hospital service use were identified. At 2 years, all children underwent a neurodevelopmental assessment, Bayley Scales of Infant Development (BSID-II). Details of children's medical contacts obtained by parent interview were cross-checked against GP and hospital records/databases. RESULTS: Very preterm infants had a similar number of GP visits to term infants but more outpatient hospital visits. Fifty-three (55%) very preterm infants were admitted to hospital on 131 occasions compared with 26 (26%) term infants on 37 occasions (p<0.001). The main reason for hospitalisation in the preterm cohort was respiratory disorder. The frequency of hospital admissions was significantly related to birthweight (P=0.01), gestational age (P<0.001) and the number of people living in the family household (P=0.02). No associations were found between hospital admission and neurodevelopment at 2 years. CONCLUSION: Very preterm infants had higher rates of hospital admissions and visits than term infants unrelated to neurodevelopmental outcome at 2 years of age. These findings highlight that very preterm birth is associated with ongoing health morbidity.     

超未成熟儿的生存状况与预后影响因素分析

目的 探讨胎龄28 周以下超未成熟儿在新生儿重症监护病房（NICU）的存活率、住院期间并发症发生情况及其预后。方法 收集2011 年1 月至2013 年3 月入住NICU 的胎龄结果 90 例患儿平均胎龄26±1 周,出生体重898±165 g,总存活率为57%,病死率9%,放弃率34%。常见并发症包括新生儿呼吸窘迫综合征（RDS）88%、BPD 85%、PDA 69%, ROP 68%,Ⅲ、Ⅳ级IVH 31%;存活早产儿平均住院时间为83±18 d,出院平均体重为2419±300 g。多因素logistic 回归分析发现,肺出血与严重IVH 为死亡或放弃的高危因素,产前使用糖皮质激素为保护因素。结论 目前国内超未成熟儿存活率相比发达国家仍有较大差距;肺出血、严重IVH 为影响预后的重要因素。     

孕妇B族链球菌定植及其早产儿感染状况的研究

目的探讨孕妇B族溶血性链球菌（GBS）定植及其分娩早产儿的GBS感染状况,评估早产儿GBS定植的危险因素。方法采用前瞻性队列研究方法,纳入2017年1月至2018年1月分娩的859例早产孕妇作为研究对象。入院时采集孕妇阴道下段1/3和直肠拭子行GBS培养,其中515例行实时PCR GBS DNA检测。采集所纳入孕妇分娩的早产儿的口咽分泌物、胃液或血液进行GBS培养。取孕妇外周血及其分娩的早产儿脐血测定抗GBS荚膜多糖抗体水平。调查早产儿GBS感染情况和影响定植的围产因素。结果 859例孕妇阴道、直肠GBS培养阳性率为14.8%（127/859）。515例GBS DNA检测的阳性率为15.1%（78/515）。859例孕妇共分娩活产早产儿976例,其中43例（4.4%）GBS培养阳性;4例发生早发型GBS疾病,其中2例肺炎,2例早发型GBS败血症。127例GBS阳性孕妇分娩的127例早产儿中,34~<37周早产儿组GBS阳性率明显低于<34周早产儿组（P=0.013）,抗GBS荚膜多糖抗体水平明显高于<34周早产儿组（P=0.001）。多因素logistic回归分析显示胎膜早破>18 h和绒毛膜羊膜炎是早产儿GBS定植的独立危险因素（分别OR=6.556、6.160,均P < 0.05）。结论早产儿GBS阳性率及抗GBS荚膜多糖抗体水平与胎龄相关。胎膜早破>18 h和绒毛膜羊膜炎可增加早产儿GBS定植的风险。     

The effect of socioeconomic status on the language outcome of preterm infants at toddler age

Background

Independently, both prematurity and low socioeconomic status (SES) compromise language outcome but less is known regarding the effects of low SES on outcome of prior preterm infants at toddler age.

Aim

To assess SES effects on the language outcome of prior preterm infants at toddler age.

Study design

Retrospective chart review of infants born at ≤ 32 weeks, matched for gestational age (GA), birth weight (BW), chronic lung disease (CLD), periventricular leukomalacia (PVL), right and left intraventricular hemorrhage (IVH-R, L), and age at Bayley Scales of Infant Development III (BSID-III) testing.

Subjects

Using insurance status as a proxy for SES, 65 children with private insurance (P-Ins) were matched with 65 children with Medicaid-type insurance (M-Ins).

Outcome measures

Bayley Scales of Infant Development-III Language Composite.

Results

M-Ins vs. P-Ins were similar in GA, BW, and age at BSID-III testing (mean 22.6 months adjusted), as well as other matched characteristics (all p ≥ 0.16). BSID-III Language Composite scores were lower in M-Ins than P-Ins (87.9 ± 11.3 vs. 101.9 ± 13.6) with a clinically significant effect size of 0.93 (p < 0.001). Overall, 45% of M-Ins exhibited mild to moderate language delay compared to 8% of P-Ins. Receptive and Expressive subscale scores also were lower in M-Ins than in P-Ins (both p < 0.001).

Conclusions

In this preterm cohort, by toddler age, M-Ins was associated with lower scores on measures of overall language as well as receptive and expressive language skills. Our findings, showing such an early influence of SES on language outcome in a cohort matched for biomedical risk, suggest that very early language interventions may be especially important for low SES preterm toddlers.     

Adverse neurodevelopmental outcome in preterm infants: risk factor profiles for different gestational ages

Aim: Assessment of risk predictors for adverse neurodevelopmental outcome at 1 year of age in preterm infants with a gestational age <30 weeks (Group I) and 30–32 weeks (Group II).
Methods: Between January 2003 and December 2006, we prospectively enrolled 310 live-born infants between 23 and 32 weeks of gestation. The association between candidate risk factors and delayed motor or mental development (Bayley Scales of infant development II; psychomotor or mental developmental index <85) was analysed by means of logistic regression analysis.
Results: Two hundred and fifty infants were eligible for follow-up, and 205 (82.0%) completed the follow-up visit. Intracerebral haemorrhage, small for gestational age and late-onset sepsis were associated with an increased risk for delayed development in Group I (p < 0.05, each). Premature rupture of membranes was a risk condition relevant to Group II. Antenatal steroids were associated with a decreased risk of neurodevelopmental delay in both groups.
Conclusion: This study identified distinct risk factors for adverse outcome in preterm infants of lower (<30 weeks) and higher (30–32 weeks) gestational age. In the lower gestational age group, neonatal risk predictors are most important. Antenatal steroids appear to decrease the risk for adverse outcome in both age groups.     

Developmental outcome of very preterm babies using an assessment tool deliverable by health visitors

AimTo assess the developmental outcome of very preterm infants using a developmental screening tool deliverable by health visitors.MethodsThe study cohort consisted of preterm infants born at <32 weeks gestation or <1500 g. Infants were assessed at 12 and 24 months corrected age using the Schedule of Growing Skills developmental screening test. Scores for skill areas were converted to developmental levels in months and graded as normal or mild, moderate or severe delay.ResultsOf 101 infants assessed at 12 months, 12 (12%) had severe developmental delay (developmental level <6months) in one or more skill areas. At 24 months, severe developmental delay (developmental level <12 months) was found in 8 (9.1%) infants. Only 3 infants had severe global delay. However, approximately a third of infants showed mild or moderate delay in hearing and language, social or cognitive skill areas by 24 months.ConclusionDevelopmental assessment undertaken by health visitors may be used to measure outcome in preterm infants. Severe developmental delay was at a level consistent with other follow-up studies of very preterm infants. Severe delay was identified by the 12-month check and was mainly in areas of motor function and language. High levels of mild to moderate developmental delay were identified at the 24-month assessment.     

单胎濒死儿发生的围生期危险因素分析（英文翻译）

目的 研究早产儿校正18~24月龄时的体格生长和神经发育水平。 方法 利用早产儿出院后随访系统,前瞻性收集2018年4月—2021年12月在暨南大学附属深圳市宝安区妇幼保健院定期随访的484例早产儿校正18~24月龄的体格生长数据和神经发育评估数据。219例足月儿作为对照。采用儿童神经心理行为检查量表2016版评估神经发育水平。根据胎龄分组（超早产儿组、极早产儿组、中期早产儿组、晚期早产儿组和足月儿组）,比较各组体格生长和神经发育水平。 结果 除中期早产儿组年龄别身长Z值高于足月儿组（P=0.038）,其余各早产儿组的体格生长指标与足月儿组比较差异均无统计学意义（均P>0.05）。各早产儿组总发育商（developmental quotient,DQ）均低于足月儿组（均P<0.05）;除社会行为能区外,超、极早产儿组其他各能区DQ均低于足月儿组（均P<0.05）;胎龄<32周早产儿全面发育迟缓发生率（16.7%）显著高于足月儿组（6.4%）（P=0.012）,全面发育迟缓发生率有随着胎龄减小而升高的趋势（P=0.026）。 结论 早产儿校正18~24月龄时体格生长可完成追赶,但神经发育水平落后于足月儿,应特别重视胎龄<32周早产儿的神经发育监测及早期干预。     

Neonatal opiate abstinence syndrome in term and preterm infants

Data on 178 term and 34 preterm infants born to methadone-maintained mothers were analyzed to assess the effects of neonatal opiate abstinence in infants of varying gestational ages. More mothers in the term group (79%) than in the preterm group (53%) had abused other drugs during pregnancy (p less than 0.001). Mean (+/- SD) gestational age was 39.5 weeks +/- 1.4 for term infants and 34.3 weeks +/- 2.6 for preterm infants. On the basis of a semiobjective symptom scoring scale, term infants had more severe abstinence symptoms and more prominent central nervous system manifestations than preterm infants. The severity of abstinence symptoms correlated with maternal methadone dosage in both term and preterm infants. Maternal multiple drug abuse (e.g., heroin, cocaine) did not influence severity of abstinence symptoms in either group. More term infants (145/178) than preterm infants (20/34) required treatment for these symptoms (p less than 0.005). In 13 of 178 term infants, compared with 1 of 34 preterm infants, abstinence-related seizures developed. Peak severity occurred 1 to 2 days earlier in term than in preterm infants. A less severe abstinence syndrome in preterm infants may be due to (1) developmental immaturity of either dendritic ramifications, specific opiate receptors, or neurotransmitter function, or (2) reduced total drug exposure during the intrauterine period.     

支气管肺发育不良早产儿振幅整合脑电图的临床意义分析

目的 了解支气管肺发育不良(BPD)早产儿振幅整合脑电图(aEEG)的变化特点及临床意义.方法 回顾性纳入出生胎龄≤32+6周符合BPD诊断的早产儿156例为BPD组,选择同期住院的非BPD早产儿156例为对照组,应用早产儿aEEG评分系统比较两组患儿住院期间的aEEG结果 ,并按检查时间(纠正胎龄≤28+6周、29～...     

甲状腺功能异常早产儿干预治疗的随访研究

目的 探讨甲状腺功能异常早产儿给予左旋甲状腺素钠片治疗后对生长发育及甲状腺功能的影响。 方法 选取2013年1月1日至2017年12月31日在云南省第一人民医院产科出生后于该院新生儿科住院,并在该院新生儿随访门诊定期随访生长发育及甲状腺功能情况的早产儿82例为研究对象行回顾性分析。根据甲状腺功能检测结果分为甲状腺功能异常组（观察组,n=31）和甲状腺功能正常组（对照组,n=51）。观察组给予口服左旋甲状腺素钠片,对照组未予干预,比较不同胎龄（28周≤胎龄<32周、32周≤胎龄<34周、34周≤胎龄<37周）两组早产儿定期随访至矫正年龄12月龄时的体格、智力发育情况及甲状腺功能的转归。 结果 不同胎龄两组早产儿随访至矫正年龄12月龄时,体格发育指标（身长、体重、头围）比较差异无统计学意义（P>0.05）。28周≤胎龄<32周和32周≤胎龄<34周早产儿Gesell发育量表各能区评分随访至矫正年龄12月龄时,在观察组和对照组间比较差异无统计学意义（P>0.05）。34周≤胎龄<37周早产儿,观察组的大运动能评分在3月龄和12月龄时低于对照组,精细动作能、语言能、适应性能评分在12月龄时均低于对照组（P<0.05）;个人-社会性能评分在3月龄时低于对照组（P<0.05）,但在12月龄时与对照组比较差异无统计学意义（P>0.05）。甲状腺功能异常早产儿给予左旋甲状腺素钠片治疗,2~4周甲状腺功能均恢复正常,甲状腺功能恢复正常并完全停药的患儿有21例（68%）,其新生儿疾病筛查结果均正常（100%）;未能停药患儿10例（32%）,仅2例筛查结果正常,与甲状腺功能恢复正常并完全停药患儿的新生儿疾病筛查结果比较差异有统计学意义（P<0.05）。 结论 甲状腺功能异常早产儿及早诊断并进行合理规范的治疗,可以在一定程度上减少对生长发育的影响。早产儿甲状腺功能异常多为暂时性,新生儿筛查结果呈阳性的早产儿发展为永久性甲状腺功能异常的可能性大。     

持续性肺膨胀在<34周早产儿中应用的Meta分析

目的 对持续性肺膨胀（SLI）在 < 34周早产儿中的应用效果进行系统评价。方法 计算机检索PubMed、Embase、Cochrane图书馆、中国知网、万方数据库、中国生物医学文献数据库、中国期刊全文数据库、中国科技期刊数据库，收集SLI对比单纯无创正压通气运用于早产儿的随机对照研究，采用Revman 5.3统计软件对符合纳入标准的临床研究进行Meta分析。结果 共纳入9项随机对照研究，合计1 432例早产儿（胎龄：23~33.7周）。Meta分析结果显示：与对照组相比，SLI组72 h内需机械通气率较对照组低（51.9% vs 56.9%；RR=0.91，P=0.04，95% CI：0.83~0.99）；两组病死率、肺表面活性物质使用率及相关并发症发生率（支气管肺发育不良、气胸、Ⅲ~Ⅳ级颅内出血）差异无统计学意义（P > 0.05）。结论 SLI可减低 < 34周早产儿机械通气的使用，且未增加其余相关并发症的风险。     

Psychopathology among preterm infants using the Diagnostic Classification Zero to Three

Aim:  To compare the prevalence of psychopathology in infants born preterm with matched full-term infants at the corrected age of 1 year.
Methods:  Between June 2003 and April 2005, a case-control longitudinal cohort study was conducted at the neonatal unit of the University Hospital of Antwerp, Belgium. We prospectively enrolled 123 live-born infants between 25 and 35 weeks of gestation and/or infants with a birth-weight of <1500 g. Thirty full-term infants were recruited among day care centres in the region. Diagnoses were based on the Diagnostic Classification Zero to Three (DC: 0–3), using the MacArthur Communicative Developmental Inventory Dutch version, Infant–Toddler Sensory Profile, Bayley Scales of Infant Development II, Parent Infant Relationship Global Assessment Scale and Functional Emotional Assessment Scale.
Results:  At the (corrected) age of 12 months, 89 infants were eligible for follow-up and complete data were available for 69 (77%) infants. Fifty-four percentage of the preterm infants fulfilled one or more DC 0–3 diagnoses. Premature infants had significantly more diagnoses than full-term infants on axis I, axis III and axis V of the DC: 0–3.
Conclusion:  In this study, the prevalence of psychopathology was significantly higher among preterm infants in comparison with full-term infants. This study did not confirm previous findings of higher rates of relationship disorders among preterm infants.     

Urinary tract infection in very low birth weight preterm infants

BACKGROUND: The prevalence of urinary tract infection (UTI) in preterm neonates ranges between 4 and 25%. The need for a radiologic investigation has not yet been established in very low birth weight premature newborns (<1500 g birth weight). PATIENTS AND METHODS: For an 11-year period (1990 to 2001), medical records of 62 very low birth weight premature infants admitted to a Level III neonatal intensive care unit and who developed UTI were reviewed retrospectively. Results of renal ultrasound and voiding cystourethrograms were compared between extremely low birth weight infants (birth weight, <1000 g) (Group A, Patient 34) and premature infants with birth weight between 1001 and 1500 g (Group B, Patient 28). RESULTS: UTI was more common in Group A (12.2%) than in Group B (5.7%) infants. Renal ultrasound detected mild renal pelvic dilatation (unilateral or bilateral) in 9 infants in Group A (26%) and in 1 infant in Group B (3.5%). Voiding cystourethrograms were performed in 26 of 34 (76%) infants in Group A and in 17 of the 28 (61%) premature infants in Group B. Vesicourethral reflux (VUR) was observed in 6 infants, 2 in group A (7.7%) and 4 in Group B (23%). CONCLUSIONS: We found that the rate of VUR was lower in very low birth weight premature newborns than that reported in the medical literature among term newborns who developed UTI. VUR was less frequent in extremely low birth weight infants who developed UTI than in infants weighing 1001 to 1500 g.     

Neonatal and neurodevelopmental outcome in infants born before 30 weeks of gestation with absent or reversed end-diastolic flow velocities in the umbilical artery

The objective of our study was to examine the outcome of infants born at a gestational age <30 weeks with absent or reversed end-diastolic flow velocity (AREDFV) in the umbilical artery in comparison with gestational age-matched eutrophic controls. A group of 40 infants who had AREDFV were matched for gestational age and date of birth with 40 appropriate for gestational age infants. Perinatal outcome variables were retrospectively reviewed. In 16 out of the 40 matched pairs, a standardized neurological examination was done and, depending on age, the Kaufman Assessment Battery for Children or the Bayley Scales of Infant Development were applied at a corrected age of 13 to 100 months to assess neurodevelopmental outcome. The results were compared using Fisher's Exact Test or Mann Whitney U Tests as appropriate. In the AREDFV group, 26/40 (65%) survived until discharge compared to 39/40 (97.5%) in the control group (P < 0.001). AREDFV was associated with a higher rate of chronic lung disease, retinopathy of prematurity ≥ grade III and impaired intestinal motility. More AREDFV infants suffered from permanent neurological sequelae compared with control infants: 44% versus 25% were mentally retarded (P=0.033), and 38% versus 19% showed severe motor impairment (P=0.073). Conclusion Absent or reversed end-diastolic flow velocity is not only associated with a higher mortality and morbidity during the neonatal period, but the surviving infants of this high risk group have an increased risk for mental retardation and severe motor impairment as compared with appropriate for gestational age preterm infants of the same gestational age. Received: 24 July 2000 and in revised form: 25 September 2000 / Accepted: 26 September 2000