Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight: 8-year-old outcomes
Cognitive and academic consequences of bronchopulmonary dysplasia and very low birth weight: 8-year-old outcomes
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DOI：
10.1542/peds.112.5.e359
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发表时间：
2003-11-01
期刊：
影响因子：
8
通讯作者：
Singer, LT
中科院分区：
文献类型：
--
作者：
Short, EJ;Klein, NK;Singer, LT
Objective.研究支气管肺发育不良（BPD）和极低出生体重（VLBW）对大样本8岁儿童认知和学习成绩的影响。对极低出生体重且患有BPD的婴儿（n = 98）或未患有BPD的婴儿（n = 75）和足月婴儿（n = 99）进行前瞻性随访至8岁。各组进行比较的措施评估4个广泛的功能领域：智力，成就，大运动，注意力技能。测量包括韦氏儿童智力量表III、伍德科克约翰逊测验修订版、Bruininks-Oseretsky运动能力测验、触觉表现测验（空间记忆）和持续表现测验（注意力）。学校的成果进行了评估，家长和教师的报告，以及从学校的记录。各组在社会经济地位、性别和种族方面具有可比性。对BPD、VLBW和足月儿的总样本进行所有结局指标的比较。此外，在本样本中评估了神经系统风险，包括以下内容：脑室内出血、回声致密病变、脑穿孔、脑积水、脑室腹腔分流、脑膜炎和脑室周围白质软化。对所有3组中神经功能完整的儿童进行个体差异分析。最后，通过比较接受类固醇治疗的BPD儿童与未接受类固醇治疗的BPD儿童，检查治疗效果。与极低出生体重儿和足月儿相比，BPD组在智力、阅读、数学和粗大运动技能以及特殊教育服务方面表现出缺陷。极低出生体重儿与足月儿在上述所有方面都不同，除了阅读识别、理解和作业治疗。注意力的差异，获得BPD和足月儿童。BPD组（54%）比VLBW（37%）或足月儿（25%）更有可能进入特殊教育班。此外，与极低出生体重儿童（11%）或足月儿（3%）相比，更多的BPD儿童（20%）在智力低下范围内达到全量表智商得分< 70，所有极低出生体重儿童比足月儿更有可能达到次平均类别的智商。在控制了出生体重和神经问题后，BPD和/或吸氧时间预测了较低的表现智商、知觉组织、全面智商、运动和注意力技能以及特殊教育安置。BPD的定性分类（存在或不存在）是一个显着的预测较低的分数的措施，应用的问题，运动技能，和发生率的语言，职业和物理治疗。进行个体差异分析，以确定风险组之间的差异是否主要归因于神经系统并发症。即使是神经系统完整的BPD和VLBW儿童样本，长期对照组与BPD和VLBW组之间的许多结果指标也存在差异。当出生体重和神经系统并发症得到控制时，BPD和BPD的严重程度与较低的表现和全面智商，较差的知觉组织，注意力和运动技能，以及较低的学校成绩和更多的特殊教育参与有关，包括职业，物理和言语语言治疗。治疗方案可能部分负责我们的BPD样本中观察到的差异。激素组和非激素组BPD儿童的操作智商差异显著（72.8 vs 84.8）和全量表IQ（77.0 vs 85.2）;知觉组织（74.0 vs 85.2）; Bruininks-Oseretsky运动能力测试评分（36.6%对44.7%）;以及参与特殊教育（78%对48%），职业治疗（71%对44%）和物理治疗（71%对41%）。在每种情况下，接受类固醇的BPD儿童比未接受类固醇的BPD儿童表现更差。BPD和吸氧时间对认知和学业成绩的长期不良影响超过VLBW的影响。在8岁时发现的问题突出了需要继续监测BPD儿童的学习，行为和发展，以干预有学校问题风险的儿童。
Objective. To examine the effects of bronchopulmonary dysplasia (BPD) and very low birth weight (VLBW) on the cognitive and academic achievement of a large sample of 8-year-old children.Methods. Infants who were VLBW and had BPD (n = 98) or did not have BPD (n = 75) and term infants (n = 99) were followed prospectively to age 8. Groups were compared on measures assessing 4 broad areas of functioning: intelligence, achievement, gross motor, and attentional skills. Measures included the Wechsler Intelligence Scale for Children III, the Woodcock Johnson Test of Achievement-Revised, the Bruininks-Oseretsky Test of Motor Proficiency, the Tactual Performance Test ( spatial memory), and the Continuous Performance Test ( attention). School outcomes were assessed by parent and teacher report, as well as from school records. Groups were comparable on socioeconomic status, sex, and race. The total sample of BPD, VLBW, and term children was compared on all outcome measures. In addition, neurologic risk was assessed in the present sample and included the following: intraventricular hemorrhage, echodense lesions, porencephaly, hydrocephalus, ventriculoperitoneal shunt, meningitis, and periventricular leukomalacia. Individual difference analyses were conducted for neurologically intact children in all 3 groups. Finally, treatment effects were examined by comparing BPD children who had received steroids as part of their treatment with BPD children who had not.Results. The BPD group demonstrated deficits compared with VLBW and term children in intelligence; reading, mathematics, and gross motor skills; and special education services. VLBW children differed from term children in all of the above areas, except reading recognition, comprehension, and occupational therapy. Attentional differences were obtained between BPD and term children only. The BPD group (54%) was more likely to be enrolled in special education classes than VLBW (37%) or term children (25%). In addition, more BPD children (20%) achieved full-scale IQ scores < 70, in the mental retardation range, compared with either VLBW (11%) or term (3%) children, with all VLBW children significantly more likely than term children to achieve IQs in the subaverage category. After controlling for birth weight and neurologic problems, BPD and/or duration on oxygen predicted lower performance IQ, perceptual organization, full-scale IQ, motor and attentional skills, and special education placement. The qualitative classification of BPD ( present or absent) was a significant predictor for lower scores on measures of applied problems; motor skills; and incidence of speech-language, occupational, and physical therapies. Individual difference analyses were performed to ascertain whether differences between the risk groups were primarily attributable to neurologic complications. Even with the neurologically intact sample of BPD and VLBW children, differences between the term comparison group and both the BPD and VLBW groups were found for many outcome measures. When birth weight and neurologic complications were controlled, BPD and severity of BPD were associated with lower performance and full-scale IQ, poorer perceptual organization, attention, and motor skills, as well as lower school achievement and greater participation in special education, including occupational, physical, and speech-language therapies. Treatment protocol may in part be responsible for differences observed in our BPD sample. Steroid and nonsteroid groups of BPD children differed significantly in performance IQ ( 72.8 vs 84.8) and full- scale IQ (77.0 vs 85.2); perceptual organization (74.0 vs 85.2); Bruininks-Oseretsky Test of Motor Proficiency score (36.6 vs 44.7); and participation in special education (78% vs 48%), occupational therapy (71% vs 44%), and physical therapy ( 71% vs 41%). In every instance, BPD children who received steroids fared more poorly than BPD children who did not receive steroids.Conclusions. BPD and duration on oxygen have long-term adverse effects on cognitive and academic achievement above and beyond the effects of VLBW. The problems that have been identified at 8 years of age highlight the need for continued monitoring of the learning, behavior, and development of BPD children to intervene with children who are at risk for school problems.