Gender Affects Long-Term Neurological Outcome of neonates

Publication date: Available online 24 April 2017
Source:Pediatric Neurology
Author(s): Amir Freud, Eyal Sheiner, Tamar Wainstock, Daniella Landau, Asnat Walfisch
ObjectiveTo evaluate a possible association between fetal gender and long-term pediatric neurological morbidity.Study designA population-based retrospective cohort analysis was performed comparing the risk of long-term neurological morbidity (up to the age of 18 years) of children born during the years 1991-2013 according to their gender. Neurological morbidity evaluated included hospitalizations in childhood involving pervasive developmental disorder, obstructive sleep apnea, cerebral palsy, epilepsy and infantile spasms and disorders of eating as recorded in the hospital files. Multiple pregnancies and fetal congenital malformations were excluded. Kaplan-Meier survival curves were constructed to compare the cumulative neurological morbidity over the study period. A Cox proportional hazards model was used to control for obstetrical confounders, including gestational age at birth, birth weight, and maternal factors.ResultsDuring the study period, 240 953 newborns were included in the long-term analysis; 51.0% (n=122 840) males and 49.0% (n=118 113) females. Neurological hospitalizations (up to the age of 18 years) were significantly more common in males as compared with females (1.1% vs. 0.8% respectively, OR 1.31, 95% CI 1.2-1.4, p<0.001). Specifically, pervasive developmental disorder and obstructive sleep apnea were found to be significantly more common in males, and cerebral palsy reached borderline significance (0.1% vs. 0.04%, OR 1.39, 95% CI 0.9-1.9, p=0.06). The Kaplan-Meier survival curves demonstrated males to have a significantly higher cumulative incidence of total neurological morbidity as well as of pervasive developmental disorder and obstructive sleep apnea (all Log rank p values <0.001). In the Cox regression model, male gender exhibited an independent association with long-term neurological morbidity, while adjusting for birthweight, gestational age, and other confounding variables (aHR 1.29, 95%CI 1.2-1.4, p<0.001).ConclusionMales are at an increased risk for pediatric neurological morbidity independent of gestational age at birth and birthweight.



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