Neurologic and developmental disability at six years of age after extremely preterm birth.
Neurologic and developmental disability at six years of age after extremely preterm birth.
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DOI：
10.1056/nejmoa041367
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发表时间：
2005-01-06
影响因子：
158.5
通讯作者：
Samara, M
中科院分区：
文献类型：
--
作者：
Marlow, N;Wolke, D;Samara, M
背景：妊娠 26 周之前出生与婴儿在生命的头两年内神经系统和发育障碍的高患病率相关。方法：我们研究了 1995 年英国和爱尔兰在 25 周或更少的妊娠周内出生的学龄早期儿童。每个孩子在 30 个月大时接受了评估。这些孩子在六岁时接受了标准化的认知和神经系统评估。根据预先确定的标准，残疾被定义为严重（表明对照顾者的依赖）、中度或轻度。 结果：在 308 名幸存儿童中，241 名（78%）的平均年龄为 6 岁零 4 个月； 160名足月交付的同学作为对照组。尽管使用测试参考标准表明，21% 的极早产儿存在认知障碍（定义为结果比平均值低 2 个标准差以上）（标准化数据中这一比例为 1%），但与同学的结果进行比较时，这一数值上升至 41%。重度、中度和轻度残疾率分别为22%、24%和34%； 30 名儿童（12%）患有致残性脑瘫。在 30 个月大时患有严重残疾的儿童中，86% 在 6 岁时仍患有中度至重度残疾。相比之下，30 个月大时的其他残疾很难预测 6 岁时的发育问题。结论：在极早产儿中，认知和神经功能障碍在学龄期很常见。与课堂上的同龄人进行比较表明，他们的损伤程度高于使用标准化规范所认识到的程度。
BACKGROUND:Birth before 26 weeks of gestation is associated with a high prevalence of neurologic and developmental disabilities in the infant during the first two years of life.METHODS:We studied at the time of early school age children who had been born at 25 or fewer completed weeks of gestation in the United Kingdom and Ireland in 1995. Each child had been evaluated at 30 months of age. The children underwent standardized cognitive and neurologic assessments at six years of age. Disability was defined as severe (indicating dependence on caregivers), moderate, or mild according to predetermined criteria.RESULTS:Of 308 surviving children, 241 (78 percent) were assessed at a median age of six years and four months; 160 classmates delivered at full term served as a comparison group. Although the use of test reference norms showed that cognitive impairment (defined as results more than 2 SD below the mean) was present in 21 percent of the children born extremely preterm (as compared with 1 percent in the standardized data), this value rose to 41 percent when the results were compared with those for their classmates. The rates of severe, moderate, and mild disability were 22 percent, 24 percent, and 34 percent, respectively; disabling cerebral palsy was present in 30 children (12 percent). Among children with severe disability at 30 months of age, 86 percent still had moderate-to-severe disability at 6 years of age. In contrast, other disabilities at the age of 30 months were poorly predictive of developmental problems at 6 years of age.CONCLUSIONS:Among extremely preterm children, cognitive and neurologic impairment is common at school age. A comparison with their classroom peers indicates a level of impairment that is greater than is recognized with the use of standardized norms.