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ORIGINAL ARTICLE |
1 Peter Dunn Neonatal Intensive Care Unit, St Michaels Hospital, Bristol, UK
2 Cardiovascular Genetics, University College London, London, UK
3 Department of Clinical Science, University of Bristol, Southmead Hospital, Bristol, UK
4 School of Human Development, University of Nottingham, Nottingham, UK
Correspondence to:
Correspondence to:
D Harding
St Michaels NICU, University of Bristol, D level, St Michaels Hospital, Bristol BS2 8EG, UK; david.harding{at}bristol.ac.uk
Background: Cyclo-oxygenase (COX) inhibition by indomethacin does not result in an improvement in long-term neurocognitive outcome, despite reducing the incidence of both severe intraventricular haemorrhage and white matter injury visible on ultrasound. Diffuse brain injury after preterm birth may have inflammatory origins. These two points suggest that, in the preterm brain, COX inhibition may have a dominant proinflammatory or neuropathological role. The inducible form of the COX2 gene is polymorphic: the 765 C (rather than G) variant of the gene is associated with reduced COX2 activity.
Objective: To test the hypothesis that the C allele of COX2 is associated with worse neurodevelopmental outcomes after premature birth.
Outcomes: Cerebral palsy, disability, Griffiths developmental quotient at 2 years and British Ability Scales-11 general cognitive ability and motor performance (movement assessment battery for children) at 5
years were compared with COX2 genotype.
Results: The C allele (GC 65 (31%), CC 3 (1%)) was independently associated with worse cognitive performance at 2 and 5
years: C allele mean (SEM) developmental quotient 92.7 (1.7), v GG 97.6 (1.5), p = 0.039; C allele mean (SEM) general cognitive ability, 94.3 (2.2) v GG 100.9 (1.7), p = 0.028.
Conclusion: An antineuropathological role for COX2 in the preterm brain may help account for the lack of effect of indomethacin treatment in improving neurocognitive outcomes in children born preterm, despite reported reduction in apparent brain injury.
Abbreviations: BAS, British Ability Scales-11; COX2, cyclo-oxygenase-2; GCA, general cognitive ability; IVH, intraventricular haemorrhage; PGE2, prostaglandin E2; PVL, periventricular leucomalacia
Relevant Article
Arch. Dis. Child. Fetal Neonatal Ed. 2007 92: F79.
This article has been cited by other articles:
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D. Harding Impact of common genetic variation on neonatal disease and outcome Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2007; 92(5): F408 - F413. [Abstract] [Full Text] [PDF] |
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