大流行如何影响婴儿的神经发育？

 

概要

 

在最近发表在《美国医学会杂志》网络版上的一项研究中，研究人员调查了婴儿的神经发育障碍与诸如妊娠期接触严重急性呼吸道综合征冠状病毒2（SARS-CoV-2）和COVID-19大流行期间的出生和发育等因素之间的关联。

研究分析包括11438名在大流行期间接受筛查的婴儿和9981名在大流行前接受筛查的婴儿。在大流行期间接受筛查的婴儿中，7%（8992人中的330人）有神经发育障碍的风险增加。在691名在孕期接触过SARS-CoV-2感染的婴儿中，12%（77人）有神经发育障碍的风险增加。

研究结论表明，感染期间母体免疫激活引起的炎症反应会影响胎儿的神经元发育。虽然没有足够的证据表明SARS-CoV-2会从母体垂直传播给胎儿，但SARS-CoV-2感染后的母体免疫反应对胎儿神经发育的影响也没有得到全面的探讨。

该研究还讨论了可能可以解释大流行期间中婴儿沟通障碍的潜在因素。在大流行期间，由于社会隔离和经济负担，父母亲的焦虑和压力增加，可能导致自身缺乏情感反应，特别是母亲，这可能使得婴儿语言发展所需的行为交流大量减少。此外，大流行病造成的社会隔离也减少了婴儿通常接触到的外部家庭经验，如游戏小组和与大家庭的访问，这可能阻碍了社会和语言的发展。

 

How has the COVID pandemic affected neurodevelopmental in infants?

 

In a recent study published in the journal JAMA Network Open, researchers investigated the association between neurodevelopmental impairment in infants and factors such as gestational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 and birth and development during the coronavirus disease 2019 (COVID-19) pandemic.

 

Study: COVID-19 Pandemic and Infant Neurodevelopmental Impairment. Image Credit: Explode / Shutterstock

 

Background

 

Endogenous and exogenous factors during gestation, such as the vertical transmission of maternal infection, direct infection to the fetus, maternal diet, immune responses in the mother, and maternal stress, are known to affect the neurodevelopment of the fetus. In addition, impaired communication skills, cognition, and psychomotor skills are associated with neurodevelopmental disorders such as attention-deficit hyperactivity disorder and autism spectrum disorder.

 

Studies suggest that inflammatory responses due to maternal immune activation during infections can affect the neuronal development of the fetus. Although there is not enough evidence of vertical transmission of SARS-CoV-2 from the mother to the fetus, the impact of maternal immune responses to a SARS-CoV-2 infection on the neurodevelopment of the fetus has not been comprehensively explored either.

 

Furthermore, while studies have not found associations between lower neurodevelopmental scores and exposure to maternal COVID-19 infections, overall, infants born and raised during the COVID-19 pandemic displayed lower personal-social and gross and fine motor skill scores as compared to pre-pandemic infants. This highlights the need to understand the impact of maternal SARS-CoV-2 infections and being raised during the COVID-19 pandemic on the neuronal development of the infant.

 

About the study

 

In the present study, the researchers conducted a systematic review of observational studies that included a neurodevelopmental screening of infants during the COVID-19 pandemic. They evaluated the neurodevelopmental impairment risk associated with maternal SARS-CoV-2 infection status. Eight studies were selected based on the inclusion criteria, and meta-analysis was performed on the data from those studies.

 

A parent-completed questionnaire comprising 30 items evaluating the ability, behavior, or skill related to communication, problem-solving, gross and fine motor skills, and personal-social developmental domains were used for the meta-analysis. To each of the questions, the parents responded with a “yes,” “sometimes,” or “not yet,” which had a score of 10, five, and zero, respectively. The neurodevelopment was categorized as normal if the cumulative score for each developmental domain was above the cutoff. If the score was two standard deviations below the mean, it indicated a risk of neurodevelopmental impairment.

 

The study's primary outcome was measuring the prevalence of neurodevelopmental impairment risk among infants who underwent neurodevelopmental screening during the COVID-19 pandemic. The secondary outcome was to compare the risk of neurodevelopmental impairment in infants exposed during gestation to maternal SARS-CoV-2 infections and those without gestational exposure to the infection. 

 

Results

 

The results reported no significant difference in the overall risk of neurodevelopmental impairment among infants that underwent neurodevelopmental screening during the COVID-19 pandemic compared to those who were screened before the pandemic, except in the communication domain. The study also reported no associations between maternal SARS-CoV-2 infections and neurodevelopmental impairment in any domains except increased odds of fine motor skill impairment.

 

The meta-analysis included 11,438 infants screened during the pandemic and 9,981 infants who underwent pre-pandemic screening. Of the infants screened during the pandemic, 7% (330 out of 8,992) were at increased risk of neurodevelopmental impairment. Among the 691 infants who experienced exposure to SARS-CoV-2 infections during gestation, 12% (77) were at increased risk of neurodevelopmental impairment.

 

The study discussed the potential factors that could explain communication impairment among infants in the pandemic cohort. The increased anxiety and stress in mothers and fathers due to social isolation and financial burden during the pandemic could result in a lack of emotional responsiveness, especially in mothers, which could decrease the behavioral exchanges required for language development in infants. Furthermore, the social isolation imposed by the pandemic also decreased the outside home experiences that an infant is generally exposed to, such as playgroups and visits with extended family, which could have hindered social and language development.

 

Conclusions

 

To summarize, the review and meta-analysis explored the association between neurodevelopmental impairment in infants and factors such as gestational exposure to SARS-CoV-2 infections and being raised during the COVID-19 pandemic.

 

Overall gestational exposure to SARS-CoV-2 did not significantly impact neuronal development. Furthermore, infants raised during the COVID-19 pandemic were not at increased risk of neurodevelopmental impairment in any developmental domains except communication, compared to the pre-pandemic cohort.

 

The absence of outside home experiences which promote language and social development and the reduced emotional responsiveness in parents due to pandemic-related stress could explain the impaired development in the communication domain among infants raised during the COVID-19 pandemic.

 

Source:

News-Medical

Published on November 1, 2022

 

 

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