Antenatal antecedents of a small head circumference at age 24-months post-term equivalent in a sample of infants born before the 28th post-menstrual week

作者：Leviton Alan^*; Kuban Karl; Allred Elizabeth N; Hecht Jonathan L; Onderdonk Andrew; O'Shea T Michael; McElrath Thomas; Paneth Nigel

来源：Early Human Development, 2010, 86(8): 515-521.

DOI：10.1016/j.earlhumdev.2010.07.001

• Microcephaly
• Epidemiology

Background: Little is known about the antecedents of microcephaly in early childhood among children born at extremely low gestational age.
Aim: To identify some of the antecedents of microcephaly at age two years among children born before the 28th week of gestation.
Study design: Observational cohort study.
Subjects: 1004 infants born before the 28th week of gestation.
Outcome measures: Head circumference Z-scores of <-2 and >=-2, <-1.
Results: Risk of microcephaly and a less severely restricted head circumference decreased monotonically with increasing gestational age. After adjusting for gestational age and other potential confounders, the risk of microcephaly at age 2 years was increased if microcephaly was present at birth [odds ratio: 8.8 ((95% confidence interval: 3.7, 21)]. alpha hemolytic Streptococci were recovered from the placenta parenchyma [2.9 (1.2, 6.9)], the child was a boy [2.8 (1.6, 4.9)], and the child's mother was not married [2.5 (1.5, 4.3)]. Antecedents associated not with microcephaly, but with a less extreme reduction in head circumference were recovery of Propionibacterium sp from the placenta parenchyma [2.9 (1.5, 5.5)], tobacco exposure [2.0 (1.4. 3.0)], and increased syncytial knots in the placenta [12.0 (1.2. 3.2)].
Conclusions: Although microcephaly at birth predicts a small head circumference at 2 years among children born much before term, pregnancy and maternal characteristics provide supplemental information about the risk of a small head circumference years later. Two findings appear to be novel. Tobacco exposure during pregnancy, and organisms recovered from the placenta predict reduced head circumference at age two years.

• 出版日期2010-8