Associations between preterm birth, small-for-gestational age, and neonatal morbidity and cognitive function among school-age children in Nepal.
Associations between preterm birth, small-for-gestational age, and neonatal morbidity and cognitive function among school-age children in Nepal.
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DOI：
10.1186/1471-2431-14-58
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发表时间：
2014-02-27
期刊：
影响因子：
2.4
通讯作者：
Khatry SK
中科院分区：
文献类型：
--
作者：
Christian P;Murray-Kolb LE;Tielsch JM;Katz J;LeClerq SC;Khatry SK
低出生体重（LBW）、早产、小于胎龄儿（SGA，定义为给定胎龄的出生体重小于参考值的第10百分位数）和早期新生儿发病率对功能结局的长期影响在低收入环境中没有得到很好的描述。在尼泊尔农村，我们对7-9岁的儿童（n = 1927）进行了神经认知评估，这些儿童的出生条件暴露是可用的。在随访中，他们对智力、执行力和运动功能进行了测试。低出生体重（39.6%）、早产（21.2%）和SGA（55.4%）的患病率较高，而出生窒息和败血症的症状报告率分别为6.7%和9.1%。在多变量回归分析中，调整混杂因素，LBW与通用非语言智力测验（UNIT），执行功能测试和儿童运动评估组合（MABC）的得分密切相关。早产与任何测试分数均无关。相反，SGA显著（所有p < 0.005）与较低的UNIT评分相关（−2.04 SE = 0.39）; Stroop检验失败比例较高（0.06，SE = 0.02）;在调整混杂因素后，向后数字广度测试（-0.16，SE = 0.04）、MABC（0.98，SE = 0.25）和手指敲击测试（-0.66，SE = 0.22）得分较低。出生时的头围与所有的测试分数都有很强的相关性。出生窒息或败血症症状与认知或运动测试得分均无显著相关性。在这个南亚农村地区，宫内生长受限的发生率很高，可能对长期的认知、执行和运动功能产生负面影响。
The long term consequences of low birth weight (LBW), preterm birth, small-for-gestational age (SGA, defined as birth weight for given gestational age less than the 10th percentile of the reference), and early newborn morbidity on functional outcomes are not well described in low income settings. In rural Nepal, we conducted neurocognitive assessment of children (n = 1927) at 7–9 y of age, for whom birth condition exposures were available. At follow-up they were tested on aspects of intellectual, executive, and motor function. The prevalence of LBW (39.6%), preterm birth (21.2%), and SGA (55.4%) was high, whereas symptoms of birth asphyxia and sepsis were reported in 6.7% and 9.1% of children. In multivariable regression analyses, adjusted for confounders, LBW was strongly associated with scores on the Universal Nonverbal Intelligence Test (UNIT), tests of executive function, and the Movement Assessment Battery for Children (MABC). Preterm was not associated with any of the test scores. Conversely, SGA was significantly (all p < 0.005) associated with lower UNIT scores (−2.04 SE = 0.39); higher proportion failure on Stroop test (0.06, SE = 0.02); and lower scores on the backward digit span test (−0.16, SE = 0.04), MABC (0.98, SE = 0.25), and finger tapping test (−0.66, SE = 0.22) after adjusting for confounders. Head circumference at birth was strongly and significantly associated with all test scores. Neither birth asphyxia nor sepsis symptoms were significantly associated with scores on cognitive or motor tests. In this rural South Asian setting, intrauterine growth restriction is high and, may have a negative impact on long term cognitive, executive and motor function.
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