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Published on: August 25, 2014
Gender Affects Long-Term Neurological Outcome of Neonates
Amir Freud1, Eyal Sheiner1, Tamar Wainstock2
1Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Insights
Male infants face a higher risk of long-term pediatric neurological morbidity, including developmental disorders and sleep apnea, independent of birth factors. This finding highlights sex-based differences in child neurological health outcomes.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Epidemiology
Background:
- Understanding factors influencing pediatric neurological morbidity is crucial for early intervention and improved outcomes.
- Previous research has not fully elucidated the role of fetal gender in long-term neurological health.
- Identifying sex-based disparities can inform targeted healthcare strategies.
Purpose of the Study:
- To investigate the association between fetal gender and the risk of long-term pediatric neurological morbidity.
- To determine if male infants have a different risk profile for neurological conditions compared to female infants up to age 18.
Main Methods:
- Population-based retrospective cohort analysis of children born between 1991 and 2013.
- Evaluation of neurological morbidity including hospitalizations for pervasive developmental disorder, obstructive sleep apnea, cerebral palsy, epilepsy, and infantile spasms.
- Kaplan-Meier survival analysis and Cox proportional hazards modeling to assess risk and control for confounders like gestational age and birth weight.
Main Results:
- A total of 240,953 newborns were analyzed; males comprised 51.0% and females 49.0%.
- Hospitalizations for neurological problems were significantly more common in males (1.1%) versus females (0.8%) (OR 1.31, P < 0.001).
- Males showed significantly higher cumulative incidence for total neurological morbidity, pervasive developmental disorder, and obstructive sleep apnea. Male gender was an independent risk factor for long-term neurological morbidity (aHR 1.29, P < 0.001).
Conclusions:
- Male infants are at an increased risk for pediatric neurological morbidity.
- This increased risk is independent of gestational age at birth and birth weight.
- Findings suggest sex-based differences in neurological development and health outcomes in children.
Objective:
We evaluated the possible association between fetal gender and long-term pediatric neurological morbidity.
Methods:
We performed a population-based retrospective cohort analysis comparing the risk of long-term neurological morbidity (up to age 18 years) of children born during the years 1991 to 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.
Results:
During 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. Hospitalizations for neurological problems (up to age 18 years) were significantly more common in males compared with females (1.1% vs 0.8%, respectively, odds ratio 1.31, 95% confidence interval 1.2 to 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%, odds ratio 1.39, 95% confidence interval 0.9 to 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 test P values <0.001). In the Cox regression model, male gender exhibited an independent association with long-term neurological morbidity, while adjusting for birth weight, gestational age, and other confounding variables (adjusted hazard ratio 1.29, 95% confidence interval 1.2 to 1.4, P < 0.001).
Conclusion:
Males are at an increased risk for pediatric neurological morbidity independent of gestational age at birth and birth weight.
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