目的研究妊娠34周以下出生的儿童在22-26个月校正年龄时邻里风险与中度至重度神经发育障碍(NDI)之间的关系。我们假设早产的婴儿生活在高风险社区会有更大的NDI和认知风险,电机,语言延迟
我们研究了2005年至2016年间出生的1291名早产婴儿的回顾性队列,排除了先天性异常的婴儿。NDI定义为以下任何一项:Bayley婴儿和幼儿发育量表-III认知或运动综合评分<85,双侧失明,双侧听力损害,或中重度脑瘫。对产妇地址进行了地理编码,以识别人口普查区块组,并创建高风险与低风险社区组。进行双变量和回归分析以评估邻域风险对结果的影响。
比较了来自高风险(n=538;42%)和低风险(n=753;58%)社区的婴儿。在双变量分析中,NDI和认知的风险,电机,在高风险社区,语言延迟更大。在调整后的回归模型中,NDI的风险(或,1.43;95%CI,1.04-1.98),认知延迟(或,1.62;95%CI,1.15-2.28),和语言延迟(OR,1.58;95%CI,1.15-2.16)在高风险社区中更高。出院时的母乳在低风险社区中更为常见,并且在回归分析中对NDI具有保护作用。
高邻里风险为早产不良NDI提供了独立的贡献,认知,和语言结果。此外,出院时的母乳是保护性的。对邻里风险的了解可能会为有针对性地实施针对社会弱势婴儿的计划提供信息。
To study the association between neighborhood risk and moderate to severe neurodevelopmental impairment (NDI) at 22-26 months corrected age in children born at <34 weeks of gestation. We hypothesized that infants born preterm living in high-risk neighborhoods would have a greater risk of NDI and cognitive, motor, and language delays.
We studied a retrospective cohort of 1291 infants born preterm between 2005 and 2016, excluding infants with congenital anomalies. NDI was defined as any one of the following: a Bayley Scales of Infant and Toddler Development-III Cognitive or Motor composite score <85, bilateral blindness, bilateral hearing impairment, or moderate-severe cerebral palsy. Maternal addresses were geocoded to identify census block groups and create high-risk versus low-risk neighborhood groups. Bivariate and regression analyses were run to assess the impact of neighborhood risk on outcomes.
Infants from high-risk (n = 538; 42%) and low-risk (n = 753; 58%) neighborhoods were compared. In bivariate analyses, the risk of NDI and cognitive, motor, and language delays was greater in high-risk neighborhoods. In adjusted regression models, the risks of NDI (OR, 1.43; 95% CI, 1.04-1.98), cognitive delay (OR, 1.62; 95% CI, 1.15-2.28), and language delay (OR, 1.58; 95% CI, 1.15-2.16) were greater in high-risk neighborhoods. Breast milk at discharge was more common in low-risk neighborhoods and was protective of NDI in regression analysis.
High neighborhood risk provides an independent contribution to preterm adverse NDI, cognitive, and language outcomes. In addition, breast milk at discharge was protective. Knowledge of neighborhood risk may inform the targeted implementation of programs for socially disadvantaged infants.