Association between mechanical ventilation and neurodevelopmental disorders in a nationwide cohort of extremely low birth weight infants |
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| Affiliation: | 1. Institute of Clinical Medicine, National Cheng Kung University College of Medicine, Tainan 701, Taiwan;2. Division of Neonatology, Chi Mei Medical Center, Tainan 710, Taiwan;3. Department of Occupational Therapy, National Cheng Kung University College of Medicine, Tainan 701, Taiwan;4. Department of Pediatrics, Chi Mei Medical Center, Tainan 710, Taiwan;5. Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan;6. Department of Biochemistry and Molecular Biology, National Cheng Kung University College of Medicine, Tainan 701, Taiwan;7. Institute of Basic Medical Sciences, National Cheng Kung University College of Medicine, Tainan 701, Taiwan;1. National Institute of Education, Nanyang Technological University, Singapore;2. RTI International, USA;1. Department of Child Rehabilitation, Rehabilitation Centre, Sint Maartenskliniek, Postbox 9011, 6500 GM Nijmegen, The Netherlands;2. Institute of Health Studies, HAN University of Applied Sciences, Postbox 6960, 6503 GL Nijmegen, The Netherlands;3. School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville City, Queensland 4811, Australia;4. Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Postbox 9600, 2300 RC Leiden, The Netherlands;5. Sint Maartenskliniek Research, Postbox 9011, 6500 GM Nijmegen, The Netherlands;6. Achmea Health Insurance Company, Postbox 1717, 3800 BS Amersfoort, The Netherlands;7. Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Postbox 9101, 6500 HB Nijmegen, The Netherlands;1. Servicio de Neonatología, Hospital 12 de Octubre, Madrid, Spain;2. Departamento de Psicología Evolutiva y de la Educación, UNED: Universidad Nacional de Educación a Distancia, Madrid, Spain;1. School of Physical Education and Sport Science, Democritus University of Thrace, Greece;2. Faculty of Physical Education and Sport Science, National Kapodestrian University of Athens, Greece |
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| Abstract: | Mechanical ventilation for preterm infants independently contributes to poor neurodevelopmental performance. However, few studies have investigated the association between the duration of mechanical ventilation and the risk for various developmental disorders in extremely low birth weight (ELBW) (<1000 g) infants. Using a large nationwide database, we did a 10-year retrospective follow-up study to explore the effect of mechanical ventilation on the incidence of cerebral palsy (CP), autism spectrum disorder (ASD), intellectual disability (ID), and attention-deficit/hyperactivity disorder (ADHD) in ELBW infants born between 1998 and 2001. Seven hundred twenty-eight ELBW infants without diagnoses of brain insults or focal brain lesions in the initial hospital stay were identified and divided into three groups (days on ventilator: ≦2, 3–14, ≧15 days). After adjusting for demographic and medical factors, the infants in the ≧15 days group had higher risks for CP (adjusted hazard ratio: 2.66; 95% confidence interval: 1.50–4.59; p < 0.001) and ADHD (adjusted hazard ratio: 1.95; 95% confidence interval: 1.02–3.76; p < 0.05), than did infants in the ≦2 days group. The risk for ASD or ID was not significantly different between the three groups. We conclude that mechanical ventilation for ≧15 days increased the risk for CP and ADHD in ELBW infants even without significant neonatal brain damage. Developing a brain-protective respiratory support strategy in response to real-time cerebral hemodynamic and oxygenation changes has the potential to improve neurodevelopmental outcomes in ELBW infants. |
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| Keywords: | Attention-deficit/hyperactivity disorder Autism spectrum disorder Cerebral palsy Extremely low birth weight infants Intellectual disability Mechanical ventilation |
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