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Comparison of Predictive Values of Magnetic Resonance Biomarkers Based on Scan Timing in Neonatal Encephalopathy Following Therapeutic Hypothermia

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JOURNAL OF PEDIATRICS 2021年 239卷 101-+页

作者： Shibasaki, Jun Niwa, Tetsu Piedvache, Aurelie Tomiyasu, Moyoko Morisaki, Naho Fujii, Yuta Toyoshima, Katsuaki Aida, Noriko Kanagawa Childrens Med Ctr Dept Neonatol Yokohama Kanagawa Japan Tokai Univ Dept Radiol Sch Med 143 Shimokasuya Isehara Kanagawa 2591193 Japan Kanagawa Childrens Med Ctr Dept Radiol Yokohama Kanagawa Japan Natl Ctr Child Hlth & Dev Div Lifecourse Epidemiol Dept Social Med Tokyo Japan Natl Inst Quantum & Radiol Sci & Technol Dept Mol Imaging & Theranost Chiba Japan

Objective To determine the optimal quantitative magnetic resonance (MR) biomarker in neonatal encephalopathy following therapeutic hypothermia based on scan timing. Study design This retrospective study included 98 neonates (35-41 weeks of gestation) with neonatal encephalopathy, who underwent therapeutic hypothermia;diffusion-weighted imaging and proton MR spectroscopy were performed at 24-96 hours (n = 56) and 7-14 days (n = 92) after birth, respectively, to estimate apparent diffusion coefficient (ADC) values, N-acetylaspartate and N-acetylaspartylglutamate (tNAA), lactate, and choline concentrations, and lactate/tNAA, tNAA/choline ratios in the deep gray matter. Adverse outcomes included death or neuro-developmental impairment at 18-22 months of age. We used receiver operating characteristic curves to examine the prognostic accuracy of each MR biomarker. Results Deep gray matter tNAA concentrations showed the best prognostic value, with an area under the curve (AUC) of 0.97 and 1.00 at 24-96 hours and 7-14 days after birth, respectively. At 24-96 hours of age, ADC values, lactate concentrations, and lactate/tNAA ratios showed prognostic value with AUCs of 0.90, 0.95, and 0.97, respectively. At 7-14 days of age, the AUCs of ADC values, lactate, and lactate/tNAA ratios were 0.61, 0.67, and 0.80, respectively;these were lower than those at 24-96 hours of age. Conclusions During the first 2 weeks of life, the deep gray matter tNAA concentration was the most accurate quantitative MR biomarker. Although ADC values, lactate levels, and lactate/tNAA ratios also showed high prognostic value during 24-96 hours of life, only tNAA retained high prognostic value in the second week of life.

关键词： hypoxic ischemic encephalopathy neurodevelopmental outcome diffusion-weighted imaging magnetic resonance spectroscopy receiver operating characteristic curves analysis ADC Apparent diffusion coefficient AUC Area under the curve tCho Glycerophosphocholine and phosphocholine DWI Diffusion-weighted imaging GMFCS gross motor function classification system 1 H-MRS Proton magnetic resonance spectroscopy MR Magnetic resonance MRI Magnetic resonance imaging NPV negative predictive value PPV Positive predictive values tNAA N-acetylaspartate and N-acetylaspartylglutamate

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Development, Reliability, and Testing of a New Rating Scale for Neonatal Encephalopathy

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JOURNAL OF PEDIATRICS 2021年 235卷 83-+页

作者： Garcia-Alix, Alfredo Arnaez, Juan Arca, Gemma Agut, Thais Alarcon, Ana Martin-Ancel, Ana Girabent-Farres, Montserrat Valverde, Eva Benavente-Fernandez, Isabel Hosp St Joan de Deu Inst Recerca St Joan de Deu Passeig St Joan de Deu 2 Barcelona 08950 Spain Univ Barcelona Barcelona Spain NeNe Fdn Madrid Spain Hosp Univ Burgos Burgos Spain Hosp Clin Maternitat IDIBAPS Barcelona Spain Pompeu Fabra Univ Sch Hlth Sci Dept Physioterapy TecnoCampus Barcelona Spain Hosp Univ La Paz Madrid Spain Hosp Puerta Mar Cadiz Spain Biomed Res & Innovat Inst Cadiz INiB Cadiz Spain

Objective To develop and test the Neonatal Encephalopathy-Rating Scale (NE-RS), a new rating scale to grade the severity of neonatal encephalopathy (NE) within the first 6 hours after birth. Study design A 3-phase process was conducted: (1) design of a comprehensive scale that would be specific, sensitive, brief, and unsophisticated;(2) evaluation in a cohort of infants with neonatal encephalopathy and healthy controls;and (3) validation with brain magnetic resonance imaging findings and outcome at 2 years of age. Results We evaluated the NE-RS in 54 infants with NE and 28 healthy infants. The NE-RS had excellent internal consistency (Cronbach alpha coefficient: 0.93 [95% CI 0.86-0.94]) and reliability (intraclass correlation coefficient in the NE cohort 0.996 [95% CI 0.993-0.998;P < .001]). Alertness, posture, motor response, and spontaneous activity were the top discriminators for degrees of NE. The cut-off value for mild vs moderate NE was 8 points (area under the curve [AUC] 0.99, 95% CI 0.85-1.00) and for moderate vs severe NE, 30 points (AUC 0.93, 95% CI 0.81-0.99). The NE-RS was significantly correlated with the magnetic resonance imaging score (Spearman Rho 0.77, P < .001) and discriminated infants who had an adverse outcome (AUC 0.91, 95% CI 0.83-0.99, sensitivity 0.82, specificity 0.81, positive predictive value 0.87, negative predictive value 0.74). Conclusions The NE-RS is reliable and performs well in reflecting the severity of NE within the first 6 hours after birth. This tool could be useful when assessing clinical criteria for therapeutic hypothermia in NE.

关键词： Hypoxic–ischemic encephalopathy hypothermia treatment infant newborn asphyxia aEEG Amplitude integrated electroencephalography AUC Area under the curve Bayley-III Bayley Scales of Infant and Toddler Development, Third Edition CP Cerebral palsy GMFCS gross motor function classification system MRI Magnetic resonance imaging NE Neonatal encephalopathy NE-RS Neonatal encephalopathy-rating scale

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A wearable gait analysis protocol to support the choice of the appropriate ankle-foot orthosis: A comparative assessment in children with Cerebral Palsy

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CLINICAL BIOMECHANICS 2019年 70卷 177-185页

作者： Contini, Bruno Giuseppe Bergamini, Elena Alvini, Martina Di Stanislao, Eugenio Di Rosa, Giuseppe Castelli, Enrico Vannozzi, Giuseppe Camomilla, Valentina Osped Pediat Bambino Gesu Div Pediat Neurorehabil Rome Italy Univ Rome Foro Italico Interuniv Ctr Bioengn Human Neuromusculoskeletal Rome Italy Univ Rome Foro Italico Dept Movement Human & Hlth Sci Piazza Bosis 15 I-00135 Rome Italy ITOP SpA Off Ortoped Rome Italy

Background: Cerebral Palsy is, nowadays, the most common cause of pediatric disabilities, particularly debilitating for daily living activities. While the adoption of ankle-foot orthoses is very well established as gait treatment, the choice of the most appropriate orthotic configuration is not strongly supported by scientific evidence. The aim of this study was to develop an instrumented assessment protocol based on wearable gait analysis to support clinicians in ankle-foot orthoses configuration selection. Methods: Ten children with spastic diplegic Cerebral Palsy were assessed (7 males, aged 4 to 11 years;all functionally classified as gross motor function classification system I or II, with clinical indication of conservative treatment through use of ankle-foot orthoses). They performed a 10Meter Walk Test in three conditions: barefoot and wearing alternatively a polypropylene hinged and solid ankle-foot orthosis accommodated in the same off-the-shelf shoe model, after 20 days of daily use of each configuration. An instrumented assessment protocol based on body-mounted magneto-inertial sensors was devised to derive spatio-temporal, gait stability and symmetry biomechanical parameters within an observational pre and post cross over design. Findings: The analysis at the individual level quantitatively revealed how different patients benefited differently from the two orthoses. No general indications were obtained in favour of or against a specific configuration for the sample as a whole. Interpretation: The proposed instrumented protocol represents a quantitative and useful tool to support the clinical selection of an appropriate orthotic treatment and, potentially, in evaluating its effectiveness.

关键词： 10MWT 10-Meter Walk Test AC PT attenuation coefficient pelvic-trunk AFO ankle-foot orthosis AP antero-posterior CC cranio-caudal CP Cerebral Palsy GMFCS gross motor function classification system hAFO hinged ankle-foot orthosis iHR improved Harmonic Ratio OGS Observational Gait Scale MIMU Magneto-Inertial Measurement Unit ML medio-lateral RMS Root Mean Square RoM Range of Motion RoM P pelvic tilt Range of Motion RoM T trunk lateral bending Range of Motion RMS-P AP Pelvic Antero-Posterior Root Mean Square acceleration RMS-T ML Trunk Medio-Lateral Root Mean Square acceleration sAFO solid ankle-foot orthosis SF cadence SL step length WS walking speed postS data obtained post use for sAFO postH data obtained post use for hAFO

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Current Referral Practices for Diagnosis and Intervention for Children with Cerebral Palsy: A National Environmental Scan

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JOURNAL OF PEDIATRICS 2020年 216卷 173-+页

作者： Boychuck, Zachary Andersen, John Fehlings, Darcy Kirton, Adam Oskoui, Maryam Shevell, Michael Majnemer, Annette Bergman, Howard Burko, Benjamin Dagenais, Emmanuelle Dagenais, Lynn Darsaklis, Vasiliki Betty Leduc, Denis Li, Patricia Shiller, Mitchell Snider, Laurie Thibault, Julie Ahmed, Sara Bussieres, Andre Rodriguez, Rosario (Charo) Thomas, Keiko Shikako McGill Univ Sch Phys & Occupat Therapy Montreal PQ Canada Ctr Interdisciplinary Res Rehabil Greater Montrea Montreal PQ Canada McGill Univ Hlth Ctr Res Inst 5252 MaisonneuveRoom 3F-44 Montreal PQ H4A 3S9 Canada Univ Alberta Glenrose Rehabil Hosp Edmonton AB Canada Univ Alberta Dept Pediat Edmonton AB Canada Univ Toronto Holland Bloorview Kids Rehabil Hosp Toronto ON Canada Univ Toronto Dept Paediat Toronto ON Canada Univ Calgary Alberta Childrens Hosp Dept Pediat & Clin Neurosci Calgary AB Canada Montreal Childrens Hosp Dept Pediat Div Child Neurol Montreal PQ Canada McGill Univ Dept Family Med Montreal PQ Canada Tiny Tots Med Ctr Montreal PQ Canada Parent Child Montreal PQ Canada PT CHU St Justine Montreal PQ Canada MSc Shriners Hosp Children Montreal PQ Canada Melville Paediat Clin Westmount PQ Canada Montreal Childrens Hosp Montreal PQ Canada Childrens Care Clin Pierrefonds PQ Canada McGill Univ Dept Pediat Montreal PQ Canada

Objectives To describe current physician referral practices with respect to age at referral to medical specialists for initial diagnosis of cerebral palsy (CP) and rehabilitation specialists for intervention and to identify factors associated with delayed referral. Study design National environmental scan of 455 children diagnosed with CP who were born in Canada between 2008 and 2011, selected from 4 sites within the Canadian CP Registry (Edmonton, Calgary, Toronto, and Montreal). Two sources of information were used-children's medical charts and the population-based registry, which provided corresponding data for each child. Primary outcomes extracted from the charts were age at referral for diagnostic assessment, age at diagnosis, age at referral for rehabilitation services, and age at initial rehabilitation intervention. Twelve variables were explored as potential predictors. Descriptive statistics, bivariate analyses, and multiple linear regressions were conducted. Results Median age (in months) at referral for diagnostic assessment was 8 (mean: 12.7 +/- 14.3), diagnosis 16 (mean: 18.9 +/- 12.8), referral for rehabilitation services 10 (mean: 13.4 +/- 13.5), and rehabilitation initiation 12 (mean: 15.9 +/- 12.9). Lower maternal education, mild severity of motor dysfunction, type of CP, early discharge after birth, and region of residence explained between 20% and 32% of the variance in age at referral for assessment, diagnosis, referral for rehabilitation, and rehabilitation initiation. Conclusions Findings suggest wide variability exists in the age at which young children with CP are referred to specialists for diagnosis and intervention. User-friendly tools are therefore needed to enhance early detection and referral strategies by primary care practitioners, to ensure early interventions to optimize developmental outcomes and enhance opportunities for neural repair at a younger age.

关键词： early identification detection primary care rehabilitation CP Cerebral palsy CCPR Canadian CP Registry GMFCS gross motor function classification system

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Periventricular Hemorrhagic Infarction in Very Preterm Infants: Characteristic Sonographic Findings and Association with Neurodevelopmental Outcome at Age 2 Years

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JOURNAL OF PEDIATRICS 2020年 217卷 79-+页

作者： Cizmeci, Mehmet N. de Vries, Linda S. Ly, Linh G. van Haastert, Ingrid C. Groenendaal, Floris Kelly, Edmond N. Traubici, Jeffrey Whyte, Hilary E. Leijser, Lara M. Univ Med Ctr Utrecht Wilhelmina Childrens Hosp Dept Neonatol Utrecht Netherlands Univ Med Ctr Utrecht Brain Ctr Rudolf Magnus Utrecht Netherlands Univ Toronto Hosp Sick Children Dept Pediat Div Neonatol Toronto ON Canada Univ Toronto Mt Sinai Hosp Dept Pediat Div Neonatol Toronto ON Canada Univ Toronto Hosp Sick Children Dept Radiol Toronto ON Canada Univ Calgary Dept Pediat Sect Neonatol 3330 Hosp Dr NW Calgary AB T2N 4N1 Canada

Objective To describe the sonographic characteristics of periventricular hemorrhagic infarction (PVHI) and their association with mortality and neurodevelopmental disability in very preterm infants born in 2008-2013. Study design Retrospective multicenter observational cohort study. Diagonal PVHI size was measured and severity score assessed. PVHI characteristics were scored and temporal trends were assessed. Neurodevelopmental outcome at 2 years of corrected age was assessed using either the Bayley Scales of Infant and Toddler Development, Third Edition or the Griffiths Mental Development Scales. Multigroup analyses were applied as appropriate. Results We enrolled 160 infants with median gestational age of 26.6 weeks. PVHI was mostly unilateral (90%), associated with an ipsilateral grade III intraventricular hemorrhage (84%), and located in the parietal lobe (51%). Sixty-four (40%) infants with PVHI died in the neonatal period. Of the survivors assessed at 2 years of corrected age, 65% had normal cognitive and 69% had normal motor outcomes. The cerebral palsy rate was 42%. The composite outcome of death or severe neurodevelopmental disability was observed in 58%, with no trends over the study period (P = .6). Increasing PVHI severity score was associated with death (P < .001). Increasing PVHI size and severity score were negatively associated with gross motor scores (P = .01 and .03, respectively). Trigone involvement was associated with cerebral palsy (41% vs 14%;P = .004). Associated posthemorrhagic ventricular dilation (36%) was an independent risk factor for poorer cognitive and motor outcomes (P < .001 for both). Conclusions Increasing PVHI size and severity score were predictive of less optimal gross motor outcome and death in very preterm infants.

关键词： cranial ultrasonography periventricular hemorrhagic infarction preterm infant BSID-III Bayley Scales of Infant and Toddler Development, Third Edition GMFCS gross motor function classification system GMH-IVH Germinal matrix hemorrhage-intraventricular hemorrhage GMDS Griffiths Mental Development Scales ICC Interclass correlation coefficient IVH Intraventricular hemorrhage PVHI Periventricular hemorrhagic infarction US Ultrasonography

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A Randomized Trial of Parenteral Nutrition Using a Mixed Lipid Emulsion Containing Fish Oil in Infants of Extremely Low Birth Weight: Neurodevelopmental Outcome at 12 and 24 Months Corrected Age, A Secondary Outcome Analysis

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JOURNAL OF PEDIATRICS 2020年 226卷 142-+页

作者： Thanhaeuser, Margarita Fuiko, Renate Oberleitner-Leeb, Christiane Brandstaetter, Sophia Binder, Christoph Thajer, Alexandra Huber-Dangl, Mercedes Haiden, Nadja Pablik, Eleonore Berger, Angelika Repa, Andreas Med Univ Vienna Dept Pediat & Adolescent Med Div Neonatol Pediat Intens Care Med & Neuropediat CeMSIIS Vienna Austria Med Univ Vienna Dept Clin Pharmacol CeMSIIS Vienna Austria Med Univ Vienna Sect Med Stat CeMSIIS Vienna Austria

Objective To examine whether parenteral nutrition using a mixed lipid emulsion containing fish oil improves the neurodevelopmental outcomes of extremely low birth weight infants. Study design The study is a secondary outcome analysis of a double-blind randomized trial of 230 extremely low birth weight infants performed at a single level IV neonatal care unit (Medical University Vienna;June 2012 to June 2015). Participants received either a mixed lipid emulsion composed of soybean oil, medium chain triglycerides, olive oil, and fish oil, or a soybean oil-based lipid emulsion for parenteral nutrition. Neurodevelopment of study participants was assessed at 12 and 24 months corrected age (August 2013 to October 2017) using the Bayley Scales of Infant-Toddler Development, third edition. Results At discharge, 206 of the 230 study participants were eligible. At 12 and 24 months corrected age, 174 of 206 (85%) and 164 of 206 (80%) infants were evaluated. At 12 months, there was no significant difference in cognitive (mixed lipid: median, 95 [IQR, 85-101];soybean oil: median, 95 [IQR, 85-100];P = .71), language (mixed lipid: median, 86 [IQR, 77-94], soybean oil: median, 89 [IQR, 79-94];P = .48), or motor scores (mixed lipid: median, 88 [IQR, 76-94], soybean oil: median, 88 [IQR, 79-94];P = .69). At 24 months, there was again no significant difference in cognitive (mixed lipid: median, 95 [IQR, 80-105], soybean oil: median, 95 [IQR, 90-105];P = .17), language (mixed lipid: median, 89 [IQR, 75-97], soybean oil 89 [IQR, 77-100];P= .54), and motor scores (mixed lipid: median, 94 [IQR, 82-103], soybean oil: median, 94 [IQR, 85-103];P = .53). Conclusions Parenteral nutrition using a mixed lipid emulsion containing fish oil did not improve neurodevelopment of extremely low birth weight infants at 12 and 24 months corrected age.

关键词： docosahexaenoic acid neurodevelopmental outcome parenteral nutrition premature infant ARA Arachidonic acid Bayley-III Bayley Scales of Infant and Toddler Development, third edition DHA Docosahexaenoic acid ELBW Extremely low birth weight EPA Eicosapentaenoic acid GMFCS gross motor function classification system LC-PUFA Long-chain polyunsaturated fatty acid

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Data on the physical function of children with cerebral malaria

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DATA IN BRIEF 2021年 35卷 106961页

作者： Konno, Kento Takata, Yuichi Syogai Iryo Clin Sapporo Hokkaido 0060814 Japan Hokkaido Bunkyo Univ Fac Human Sci Dept Phys Therapy Sapporo Hokkaido 0611449 Japan

We collected data from children with motor dysfunction living in Malawi from October 2, 2017 to November 15, 2017, using questionnaires and physical examinations. These data included diagnosis, birth history, medical history, and history of malaria based on interviews and patients' personal medical records. The patients' families provided consent to participate in this research. After applying the exclusion criteria, the remaining 33 patients (27%) were diagnosed with cerebral malaria (CM). We report the patients' type of paralysis, muscle tone, age of malaria infection, and gross motor functional classification Score. This dataset reports basic data on the physical function of an underreported pediatric population with CM. Future comparative studies with other children with CM are needed to improve rehabilitation interventions. (C) 2021 The Authors. Published by Elsevier Inc.

关键词： Cerebral malaria Assessment form motor function Type of paralysis Type of muscle tone gross motor function classification system

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Parental Perspectives on Diagnosis and Prognosis of Neonatal Intensive Care Unit Graduates with Cerebral Palsy

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JOURNAL OF PEDIATRICS 2018年 203卷 156-162页

作者： Guttmann, Katherine Flibotte, John DeMauro, Sara B. Childrens Hosp Philadelphia Dept Pediat Div Neonatol Philadelphia PA 19104 USA Univ Penn Perelman Sch Med Philadelphia PA 19104 USA

Objectives To describe how parents of neonatal intensive care unit (NICU) graduates with cerebral palsy (CP) perceive both the accuracy of prognoses provided in the NICU and the timing of their child's diagnosis of CP, and to assess the influence of functional outcome on these perceptions. Study design We surveyed parents of NICU graduates with CP about timing and benefit of diagnosis, accuracy of prognosis, and functional abilities of their children. After piloting and validation, CP parent support groups circulated the survey on social media. websites, and email lists. Bivariate relationships between categorical responses to survey questions were assessed with the chi(2) test, and multivariable logistic regression was performed to identify independent factors associated with perceptions about the timing of diagnosis. Results Parents of 463 children were included. Two-thirds (67%) of the children were diagnosed with CP before age 2 years, yet 40% of the respondents felt that diagnosis was made late, and only 11% categorized diagnosis as early. More than one-half (59%) perceived a benefit to diagnosis. There was a significant association between earlier age at diagnosis and greater functional limitations;24% of parents who recalled being given a prognosis reported that their child functioned as predicted. and 46% reported that their child exceeded expectations. Parents were more likely to believe that children with fewer functional limitations had exceeded expectations. Conclusion Parents remember prognostic discussions about children who develop CP as underestimating functional outcome. Diagnosis is rarely seen as early and is associated with benefits. These observations suggest that clinicians should aim to diagnose CP early and to maintain guarded optimism about future outcomes. Tools for improved communication are urgently needed.

关键词： outcomes function hypoxic-ischemic encephalopathy intraventricular hemorrhage uncertainty neonate expectations CP Cerebral palsy GMFCS gross motor function classification system MRI Magnetic resonance imaging NICU Neonatal intensive care unit

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A Randomized Clinical Trial of Umbilical Cord Milking vs Delayed Cord Clamping in Preterm Infants: Neurodevelopmental Outcomes at 22-26 Months of Corrected Age

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JOURNAL OF PEDIATRICS 2018年 194卷 76-80页

作者： Katheria, Anup Garey, Donna Truong, Giang Akshoomoff, Natacha Steen, Jane Maldonado, Mauricio Poeltler, Debra Harbert, Mary Jane Vaucher, Yvonne E. Finer, Neil Sharp Mary Birch Hosp Women & Newborns Neonatal Res Inst 8555 Aero DrSuite 104 San Diego CA 92123 USA Columbia Univ Dept Pediat New York NY 10027 USA Loma Linda Univ Med Ctr Dept Pediat Loma Linda CA USA Univ Calif San Diego Dept Psychiat San Diego CA 92103 USA Univ Calif San Diego Dept Pediat San Diego CA 92103 USA

Objective To compare the effect of umbilical cord milking vs delayed cord clamping (DCC) on neurodevelopmental and health outcomes in very preterm infants at 22-26 months of corrected age. Study design Neurodevelopmental outcomes at 2 years of age were assessed using the Bayley Scales of Infant Development, third edition, and a standardized neurologic examination. Data regarding pulmonary morbidities, neurosensory impairments, and hospitalizations were obtained by parental interview. Intention-to-treat was used for primary analyses. Results Of the 197 infants enrolled in the original study there were 15 deaths, 5 in the umbilical cord milking group and 10 in DCC group. Of the remaining infants, 135 (74%) were assessed at 22-26 months of corrected age. Demographics in umbilical cord milking (n = 70) and DCC (n = 65) groups were similar. Infants randomized to umbilical cord milking at birth had significantly higher cognitive and language composite scores, and were less likely to have a cognitive composite score of <85 (4% vs 15%;P = .04). motor function was similar in both groups. There were no differences in the incidences of mild or moderate to severe neurodevelopmental impairment, hearing or visual impairments, pulmonary morbidities, or rehospitalizations between the 2 groups. Conclusions Infants randomized to umbilical cord milking had higher language and cognitive scores compared with those randomized to DCC. There was no difference in rates of mild or moderate to severe neurodevelopmental impairment.

关键词： placental transfusion resuscitation neonatal intraventricular hemorrhage Bayley-III Bayley Scales of Infant and Toddler Development, third edition CA Corrected age DCC Delayed cord clamping GMFCS gross motor function classification system

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Discordance in Antenatal Corticosteroid Use and Resuscitation Following Extremely Preterm Birth

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JOURNAL OF PEDIATRICS 2019年 208卷 156-+页

作者： Rysavy, Matthew A. Bell, Edward F. Iams, Jay D. Carlo, Waldemar A. Li, Lei Mercer, Brian M. Hintz, Susan R. Stoll, Barbara J. Vohr, Betty R. Shankaran, Seetha Walsh, Michele C. Brumbaugh, Jane E. Colaizy, Tarah T. Das, Abhik Higgins, Rosemary D. Caplan, Michael S. Polin, Richard A. Laptook, Abbot R. Hensman, Angelita M. Oh, William Keszler, Martin Burke, Robert Caskey, Melinda Johnson, Katharine Alksninis, Barbara Leach, Theresa M. Stephens, Bonnie E. Watson, Victoria E. Ventura, Suzy Basso, Kristin M. Vieira, Elisa Halbrook, Andrea Fanaroff, Avroy A. Hibbs, Anna Marie Wilson-Costello, Deanne E. Newman, Nancy S. Siner, Bonnie S. Bhola, Monika Yalcinkaya, Gulgun Friedman, Harriet G. Truog, William E. Pallotto, Eugenia K. Kilbride, Howard W. Gauldin, Cheri Holmes, Anne Johnson, Kathy Schibler, Kurt Donovan, Edward F. Bridges, Kate Alexander, Barbara Grisby, Cathy Hessling, Jody Fischer, Estelle E. Jackson, Lenora D. Kirker, Kristin Mincey, Holly L. Muthig, Greg Gratton, Teresa L. Steichen, Jean J. Yolton, Kimberly Goldberg, Ronald N. Goldstein, Ricki F. Fisher, Kimberley A. Auten, Kathy J. Foy, Katherine A. Grimes, Sandra Finkle, Joanne Gustafson, Kathryn E. Lohmeyer, Melody B. Laughon, Matthew M. Bose, Carl L. Bernhardt, Janice Bose, Gennie Clark, Cindy Carlton, David P. Hale, Ellen C. Adams-Chapman, Ira LaRossa, Maureen Mulligan Carter, Sheena L. Archer, Stephanie Wilson Poindexter, Brenda B. Dusick, Anna M. Cook, Ann B. Herron, Dianne E. Hamer, Faithe Lytle, Carolyn Miller, Lucy C. Minnich, Heike M. Wilson, Leslie Dawn Nelin, Leif D. Jadcherla, Sudarshan R. Luzader, Patricia Fortney, Christine A. Besner, Gail E. Parikh, Nehal A. Poole, W. Kenneth Wallace, Dennis Newman, Jamie E. Auman, Jeanette O'Donnell Crawford, Margaret M. Huitema, Carolyn M. Petrie Zaterka-Baxter, Kristin M. Van Meurs, Krisa P. Stevenson, David K. Adams, Marian M. Ball, M. Bethany Palmquist, Andrew W. Proud, Melinda S. Bruno, Elizabeth DeAnda, Maria Elena DeBattista, Anne M. Kohn, Jean G. Krueger, Casey E. Weiss, Hali E. Frantz, Ivan D., III Univ Iowa Dept Pediat 200 Hawkins Dr Iowa City IA 52242 USA Ohio State Univ Dept Obstet & Gynecol Columbus OH USA Univ Alabama Birmingham Dept Pediat Birmingham AL USA RTI Int Social Stat & Environm Sci Unit Res Triangle Pk NC USA Case Western Reserve Univ Dept Obstet & Gynecol Cleveland OH 44106 USA Stanford Univ Sch Med Dept Pediat Palo Alto CA 94304 USA Univ Texas Med Sch Houston Deans Off Houston TX USA Brown Univ Women & Infants Hosp Dept Pediat Providence RI 02908 USA Wayne State Univ Dept Pediat Detroit MI 48202 USA Case Western Reserve Univ Rainbow Babies & Childrens Hosp Dept Pediat Cleveland OH 44106 USA Mayo Clin Dept Pediat & Adolescent Med Rochester MN USA RTI Int Social Stat & Environm Sci Unit Rockville MD USA Eunice Kennedy Shriver Natl Inst Child Hlth & Hum NIH Bethesda MD USA Univ Chicago Pritzker Sch Med Chicago IL 60637 USA Columbia Univ Coll Phys & Surg Div Neonatol New York NY 10027 USA Brown Univ Alpert Med Sch Providence RI 02912 USA Women & Infants Hosp Rhode Isl Providence RI 02908 USA Case Western Reserve Univ Rainbow Babies & Childrens Hosp Cleveland OH 44106 USA Childrens Mercy Hosp Kansas City MO 64108 USA Univ Hosp Cincinnati Childrens Hosp Med Ctr Cincinnati OH USA Good Samaritan Hosp Los Angeles CA USA Duke Univ Sch Med Univ Hosp Univ North Carolina Durham NC 27706 USA Duke Reg Hosp Durham NC USA Emory Univ Grady Mem Hosp Childrens Healthcare Atlanta Atlanta GA 30322 USA Emory Univ Hosp Midtown Atlanta GA USA Eunice Kennedy Shriver Natl Inst Child Hlth & Hum Bethesda MD USA Indiana Univ Univ Hosp Methodist Hospi Riley Hosp Children & Eskenazi Hlth Bloomington IN 47405 USA Nationwide Childrens Hosp Columbus OH USA Ohio State Univ Columbus OH 43210 USA RTI Int Res Triangle Pk NC USA Stanford Univ Dominican Hosp El Camino Hosp Stanford CA 94305 USA Lucile Packard Childrens Hosp Palo Alto CA USA Tufts Med Ctr Floating Hosp Children Boston MA 02111 USA Univ Alabama Birmingham Hlth Syst

Objective To describe discordance in antenatal corticosteroid use and resuscitation following extremely preterm birth and its relationship with infant survival and neurodevelopment. Study design A multicenter cohort study of 4858 infants 22-26 weeks of gestation born 2006-2011 at 24 US hospitals participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, with follow-up through 2013. Survival and neurodevelopmental outcomes were available at 18-22 months of corrected age for 4576 (94.2%) infants. We described antenatal interventions, resuscitation, and infant outcomes. We modeled the effect on infant outcomes of each hospital increasing antenatal corticosteroid exposure for resuscitated infants born at 22-24 weeks of gestation to rates observed at 25-26 weeks of gestation. Results Discordant antenatal corticosteroid use and resuscitation, where one and not the other occurred, were more frequent for births at 22 and 23 but not 24 weeks (rate ratio [95% CI] at 22 weeks: 1.7 [1.3-2.2];23 weeks: 2.6 [2.2-3.2];24 weeks: 1.0 [0.8-1.2]) when compared with 25-26 weeks. Among infants resuscitated at 23 weeks, adjusting each hospital's rate of antenatal corticosteroid use to the average at 25-26 weeks (89.2%) was projected to increase infant survival by 7.1% (95% CI 5.4-8.8%) and survival without severe impairment by 6.4% (95% CI 4.7-8.1%). No significant change in outcomes was projected for infants resuscitated at 22 weeks, where few (n = 22) resuscitated infants received antenatal corticosteroids. Conclusions Infants born at 23 weeks were more frequently resuscitated without antenatal corticosteroids than other extremely preterm infants. When resuscitation is intended, consistent provision of antenatal corticosteroids may increase infant survival and survival without impairment.

关键词： NICHD Eunice Kennedy Shriver National Institute of Child Health and Human Development Bayley-III Bayley Scales of Infant and Toddler Development, Third Edition GMFCS gross motor function classification system

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