Risk Factors Affecting School Readiness in Premature Infants With Respiratory Distress Syndrome
Risk Factors Affecting School Readiness in Premature Infants With Respiratory Distress Syndrome
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DOI：
10.1542/peds.2008-1771
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发表时间：
2009-07-01
期刊：
影响因子：
8
通讯作者：
Schreiber, Michael D.
中科院分区：
文献类型：
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作者：
Patrianakos-Hoobler, Athena I.;Msall, Michael E.;Schreiber, Michael D.
目的：随着新生儿护理的进步，更多的早产儿童成功达到学龄。目前尚不清楚有多少人将准备好上学，以及哪些因素会影响入学准备。我们的目的是评估早产儿童进入公立学校的准备情况，并确定与这一人群中缺乏入学准备相关的风险因素。方法：这是一项单中心前瞻性队列研究。收集了167例RDS存活早产儿中135例（81%）需要表面活性剂替代治疗的随访数据。这些儿童在2005年7月至2006年9月期间（平均年龄：5.7 +/- 1.0岁）接受了标准化的神经发育和健康评估以及社会经济地位分类。根据儿童基本概念（Bracken school-readiness Assessment）、知觉技能（Visual-Motor Integration Test）、接受性词汇（Peabody Picture vocabulary Test，第三版）、日常生活功能技能（Pediatric functional Independence Measure）和感觉障碍或自闭症的存在性的标准化分数，构建了4个等级的入学准备分数。比例赔率模型用于确定预测较低入学准备水平的风险因素。结果：平均出生体重为1016±391 g，平均胎龄为27.5±2.6周。91名（67%）儿童已做好入学准备。多变量分析显示，男性、慢性肺病、严重脑室内出血或脑室周围白质软化与入学准备水平较低相关。然而，决定入学准备水平的最重要因素是低社会经济地位。结论：与贫困的社会环境相比，针对新生儿发病率的干预措施在提高学龄儿童整体表现方面的效果可能要差得多。儿科2009;124: 258 - 267
OBJECTIVE: With advances in neonatal care, more children born prematurely are successfully reaching school age. It is unknown how many will be ready for school and what factors affect school readiness. Our objective was to assess readiness of children born prematurely for entry into public school, and determine risk factors associated with lack of school readiness in this population.METHODS: This was a single-center prospective cohort study. Followup data were collected for 135 of 167 (81%) surviving premature infants with RDS requiring surfactant-replacement therapy. The children were seen between July 2005 and September 2006 ( average age: 5.7 +/- 1.0 years) and underwent standardized neurodevelopmental and health assessments and socioeconomic status classification. A 4-level school-readiness score was constructed by using each child's standardized scores on assessments of basic concepts ( Bracken School-Readiness Assessment), perceptual skills (Visual-Motor Integration Test), receptive vocabulary (Peabody Picture Vocabulary Test, Third Edition), daily living functional skills ( Pediatric Functional Independence Measure), and presence of sensory impairments or autism. Proportional odds models were used to identify risk factors predicting lower school-readiness levels.RESULTS: Mean birth weight was 1016 +/- 391 g, and mean gestational age was 27.5 +/- 2.6 weeks. Ninety-one (67%) children were school-ready. Using multivariate analysis, male gender, chronic lung disease, and severe intraventricular hemorrhage or periventricular leukomalacia were associated with lower school-readiness levels. However, the most powerful factor determining school-readiness level was low socioeconomic status.CONCLUSION: Interventions targeting neonatal morbidities may be much less effective at improving overall performance at school age compared with the effect of the impoverished social environment. Pediatrics 2009; 124: 258-267