Association between mechanical ventilation and neurodevelopmental disorders in a nationwide cohort of extremely low birth weight infants.
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) (<1000g) 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.
Institute of Clinical Medicine, National Cheng Kung University College of Medicine, Tainan 701, Taiwan; Division of Neonatology, Chi Mei Medical Center, Tainan 710, Taiwan.
Wen-Hui
WH
Tsai
Department of Occupational Therapy, National Cheng Kung University College of Medicine, Tainan 701, Taiwan.
Yea-Shwu
YS
Hwang
Department of Pediatrics, Chi Mei Medical Center, Tainan 710, Taiwan.
Te-Yu
TY
Hung
Department of Medical Research, Chi Mei Medical Center, Tainan 710, Taiwan.
Shih-Feng
SF
Weng
Department of Pediatrics, Chi Mei Medical Center, Tainan 710, Taiwan.
Shio-Jean
SJ
Lin
Department of Biochemistry and Molecular Biology, National Cheng Kung University College of Medicine, Tainan 701, Taiwan; Institute of Basic Medical Sciences, National Cheng Kung University College of Medicine, Tainan 701, Taiwan. Electronic address: wtchang@mail.ncku.edu.tw.
Wen-Tsan
WT
Chang
D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000209:etiology; D002547:Cerebral Palsy / Q000453:epidemiology / Q000209:etiology; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology / Q000209:etiology; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D052577:Infant, Extremely Low Birth Weight / Q000523:psychology*; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000453:epidemiology / Q000209:etiology; D007363:Intensive Care Units, Neonatal; D007902:Length of Stay; D008297:Male; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan
Attention-deficit/hyperactivity disorder; Autism spectrum disorder; Cerebral palsy; Extremely low birth weight infants; Intellectual disability; Mechanical ventilation