Influence of early clinical problems on the early neurological outcome in preterm infants : Research Clerkship Neonatology

Hempenius, M.A. (Maaike-Anna) (2016) Influence of early clinical problems on the early neurological outcome in preterm infants : Research Clerkship Neonatology. thesis, Medicine.

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Abstract

Objective:Our aim was to determine whether frequently occurring clinical problems including mechanical ventilation, patent ductus arteriosus (PDA) and disturbances in the glucose homeostasis had predictive value for the quality of general movements (GMs) in preterm children. Methods: In this cohort study, we included 67 preterm infants (gestational age, median: 30.1 weeks [range: 26.0 – 32.1 weeks]; birth weight,median: 1200 g [range: 560 – 2250 g]) without congenital malformations and chromosomal abnormalities.Prospectively we obtained video recordings of the general movements (GMs) of the infants at day 8 and day 15 postnatally. Retrospectively we retrieved data from the medical files regarding the presence and duration of ventilatory support, presence of PDA and disturbances in glucose homeostasis. The video recordings were scored offline. We scored the quality of GMs globally as normal or abnormal and detailed aspects using a motor optimality score (MOS-42), leading to scores between 5 and 42. The higher the MOS-42, the better the quality of the detailed aspects of the GMs. Next, we determined the association between qualitative aspects of GMs and clinical variables, using nonparametric and parametric tests, where appropriate. Because the MOS-42 was normally distributed, we finally constructed multivariable linear regression models, including all variables with P < 0.15 in the univariable analyses, to determine independent associations with MOS-42. Results:Of the cohort, 44 (66%) children were intubated and 11 (17%) still received mechanical ventilation at day 15; 27 (40%)of the children had a PDA; 17 (25%) of the children had at least once hypoglycemia (blood glucose <2.6 mmol/l) and 3 (4%) children had at least once hyperglycemia (blood glucose > 10.0 mmol/l). Regarding GMs, 11 (20%) and 12 (32%)of the children were scored as normal on day 8 and 15, respectively. The MOS-42 was median 27 [range: 18 - 42] for day 8 and 32 [range: 18 - 42] for day 15. At day 8 only PDA remained in the final multivariable linear regression model independently, explaining 21.3% of the variance in MOS-42. At day 15 duration of ventilation and the frequency of hypoglycemia remained in the final model, explaining 38.8% of the variance of the MOS-42. Conclusions: PDA is associated with a lower quality of detailed aspects of GMs at day 8 and duration of ventilation and the frequency of hypoglycemia at day 15. As the quality of GMs is related to motor skills and intelligence later on, our data suggest that hypoglycemia and duration of ventilator support are associated with poorer motor skills and intelligence.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor: and Bos, Prof. Dr. A.F. and University Medical Center Groningen
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:45
Last Modified:	25 Jun 2020 10:45
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/689

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