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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >The discrepancy between maturation of visual-evoked potentials and cognitive outcome at five years in very preterm infants with and without hemodynamic signs of fetal brain-sparing.
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The discrepancy between maturation of visual-evoked potentials and cognitive outcome at five years in very preterm infants with and without hemodynamic signs of fetal brain-sparing.

机译：在有和没有胎儿动脑血流动力学迹象的早产婴儿中，视觉诱发电位的成熟与五年后认知结局之间的差异。

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OBJECTIVE. After intrauterine growth restriction we found at the age of 6 months an acceleration of neurophysiologic maturation. However, at later ages impaired cognitive outcome has been reported. Therefore, we investigated in children with and without fetal hemodynamic adaptation to intrauterine growth restriction whether the accelerated neurophysiologic maturation in infancy might be associated with impaired cognitive outcome at preschool age. DESIGN. At 5 years of age cognitive function was assessed using the Revision of the Amsterdam Children's Intelligence Test in 73 preterm infants (26-33 weeks) who were prospectively followed from the antenatal period up to the age of 5 years. Maternal educational level was used as a background variable to estimate the confounding effects of socioeconomic status on cognitive function. Fetal Doppler studies were performed and the umbilical artery pulsatility index (PI) divided by the middle cerebral artery PI ratio (U/C ratio) was calculated. A U/C ratio >0.725 was considered as an indication of fetal cerebral hemodynamic adaptation to a compromised placental perfusion, ie, fetal brain-sparing. Visual-evoked potentials (VEPs) were recorded at 6 months and 1 year of age. In addition, data on neurologic status at 3 years were available. RESULTS. Mean IQ score was significantly lower for children born with a raised U/C ratio (87 +/- 16) compared with children with a normal U/C ratio (96 +/- 17). VEP latencies decreased significantly in infants with a normal U/C ratio, whereas no decrease was found in infants with a raised U/C ratio. Variables contributing significantly to the variance of cognitive function were: U/C group, VEP latency maturation, level of maternal education, and neurodevelopmental outcome at 3 years. The linear regression model explained 33% of the variance in cognitive function. CONCLUSIONS. Both being born with a raised U/C ratio and an acceleration of VEP latencies are negatively associated with cognitive outcome at 5 years of age. Fetal brain-sparing, although a seemingly beneficial adaptive mechanism for intact neurologic survival, is, however, later associated with a poorer cognitive outcome.
机译：目的。宫内生长受限后，我们发现在6个月大时，神经生理成熟加快了。然而，在较晚的时期，已经报道了认知结果受损。因此，我们调查了有或没有胎儿血流动力学适应宫内生长受限的儿童，婴儿期神经生理学的加速成熟是否可能与学龄前认知功能受损有关。设计。使用阿姆斯特丹儿童智力测验修订版对5岁以下的73名早产儿（从产前到5岁进行随访）进行了认知功能评估。产妇受教育程度被用作背景变量，以评估社会经济状况对认知功能的混杂影响。进行了胎儿多普勒研究，计算了脐动脉搏动指数（PI）除以大脑中动脉PI比（U / C比）。 U / C比> 0.725被认为是胎儿脑血流动力学适应胎盘灌注受损（即胎儿脑保留）的指标。在6个月和1岁时记录视觉诱发电位（VEP）。此外，可获得3年时神经系统状况的数据。结果。与正常U / C比（96 +/- 17）的孩子相比，出生时U / C比（87 +/- 16）升高的孩子的平均智商得分要低得多。 U / C比率正常的婴儿的VEP潜伏期显着降低，而U / C比率升高的婴儿的VEP潜伏期却没有降低。显着影响认知功能差异的变量包括：U / C组，VEP潜伏期成熟度，孕产妇教育水平和3年时神经发育结局。线性回归模型解释了认知功能差异的33％。结论。出生时U / C比率升高和VEP潜伏期加快都与5岁时的认知结果负相关。保留胎儿的大脑虽然是完整神经系统存活的看似有益的适应性机制，但后来却与较差的认知结果有关。

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