Lasting effects of preterm birth and neonatal brain hemorrhage at 12 years of age.
Lasting effects of preterm birth and neonatal brain hemorrhage at 12 years of age.
复制标题
早产和新生儿脑出血的持久影响。
DOI：
10.1542/peds.2008-1162
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发表时间：
2009-03
期刊：
影响因子：
8
通讯作者：
Vohr BR
中科院分区：
文献类型：
--
作者：
Luu TM;Ment LR;Schneider KC;Katz KH;Allan WC;Vohr BR
比较早产儿与足月对照组的认知、语言、行为和教育结果，并评估新生儿脑损伤、吲哚美辛和环境危险因素对12岁时智力功能的影响。375名1989 - 1992年出生、出生体重600 - 1250g的儿童参加了吲哚美辛脑室内出血（IVH）预防试验，并在12岁时对111名期对照进行了评估。完成神经心理测试、神经学测试和教育需求访谈。重度脑损伤定义为颅内超声显示3 - 4级IVH、脑室周围白质软化或严重脑室肿大。在韦氏儿童智力量表上，早产儿的平均全量表智商为87.9±18.3，言语智商为90.8±18.9，表现智商为86.8±17.9。在调整社会人口因素后，早产儿在所有心理测试中的得分比足月对照组低6 - 14分。在语言基础临床评估（基本语言技能测试）中，22 - 24%的早产儿得分在异常范围（<70），而对照组为2 - 4%。与对照组相比，有和没有脑损伤的早产儿需要更多的学校服务（76%和44%对16%），以及在阅读（44%和28%对9%）、写作（44%和20%对4%）和数学（47%和30%对6%）方面的支持。早产儿也比早产儿表现出更多的行为问题。严重新生儿脑损伤是智力低下的最强预测因子（平均差为- 22.1；CI为- 28.1,- 16.2）。产前类固醇、较高的母亲教育程度和双亲家庭与更好的认知相关，而少数民族身份则会产生不利影响。吲哚美辛对早产儿的智力功能没有影响。上世纪90年代初出生的早产儿，尤其是那些有严重脑损伤的早产儿，在神经心理方面表现出严重的缺陷，这意味着12岁时更多地使用学校服务。
To compare cognitive, language, behavioural and educational outcomes of preterm children to term controls, and to evaluate the impact of neonatal brain injury, indomethacin and environmental risk factors on intellectual function at 12 years. 375 children born in 1989−1992 with birth weight 600−1250g enrolled in the Indomethacin Intraventricular Hemorrhage (IVH) Prevention Trial and 111 term controls were evaluated at 12 years of age. Neuropsychometric testing, neurological exam, and interviews on educational needs were completed. Severe brain injury was defined as the presence of grade 3−4 IVH, periventricular leukomalacia or severe ventriculomegaly on cranial ultrasound. On the Wechsler Scales of Intelligence for Children, the preterm cohort obtained a mean full scale IQ of 87.9 ± 18.3, verbal IQ of 90.8 ± 18.9, and performance IQ of 86.8 ±17.9. Preterm children obtained scores 6−14 points lower than term controls on all psychometric tests after adjustment for socio-demographic factors. On the Clinical Evaluation of Language Fundamentals (test of basic language skills), 22−24% of preterm children scored in the abnormal ranges (<70) as opposed to 2−4% of controls. Preterm children with and without brain injury required more school services (76% and 44% vs. 16%), and support in reading (44% and 28% vs. 9%), writing (44% and 20% vs. 4%), and mathematics (47% and 30% vs. 6%) compared to controls. Preterm children also displayed more behaviour problems than their term counterparts. Severe neonatal brain injury was the strongest predictor of poor intelligence (mean difference −22.1; CI −28.1, −16.2). Antenatal steroids, higher maternal education, and 2-parent family were associated with better cognition, whereas minority status incurred a disadvantage. Indomethacin did not affect intellectual function among preterm children. Preterm children born in the early 1990s, especially those with severe brain injury, demonstrate serious deficits in their neuropsychological profile, which translates into increased use of school services at 12 years.
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