Behavioral Problems and Cognitive Performance at 5 Years of Age After Very Preterm Birth: The EPIPAGE Study
Behavioral Problems and Cognitive Performance at 5 Years of Age After Very Preterm Birth: The EPIPAGE Study
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DOI：
10.1542/peds.2008-1216
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发表时间：
2009-06-01
期刊：
影响因子：
8
通讯作者：
Larroque, Beatrice
中科院分区：
文献类型：
--
作者：
Delobel-Ayoub, Malika;Arnaud, Catherine;Larroque, Beatrice
目的：我们比较了5岁时极早产儿和足月儿行为问题的发生频率。我们假设行为问题与认知障碍和环境因素有关，并且在对认知表现和环境因素进行调整后，两组之间的差异会减小但仍然存在。
患者与方法：“低孕周流行病学研究”（EPIPAGE）是一项基于人群的前瞻性队列研究，纳入了1997年法国9个地区所有孕周在22至32周的新生儿以及孕周在39至40周的对照组婴儿。出生时收集新生儿和产科数据。在5岁时，评估儿童的社会人口学状况、神经发育和认知发展以及母亲的心理健康状况。通过家长填写的《优势与困难问卷》对1102名无重大损伤的极早产儿和375名足月儿的行为问题进行研究。
结果：极早产儿的家长报告的行为问题明显更多，在多动/注意力不集中、情绪症状和同伴问题方面，其患病率是足月儿的两倍。行为问题与认知表现差、发育迟缓、儿童住院、母亲年龄小以及母亲心理健康状况差有关。在对认知表现和所有其他因素进行调整后，与足月儿相比，极早产儿出现行为问题的风险仍然较高。
结论：行为问题与认知障碍密切相关，但即使在对认知表现进行调整后，极早产儿出现行为问题的风险仍然较高。应鼓励对所有极早产儿进行行为问题的早期筛查，母亲的健康状况也应成为特别关注的焦点。《儿科学》2009年；123卷：1485 - 1492页
OBJECTIVES. We compared the frequency of behavioral problems in very preterm and term children at 5 years of age. We hypothesized that behavioral problems would be associated with cognitive impairment and environmental factors and that differences between the 2 groups would be reduced but persist after adjusting for cognitive performance and environmental factors.PATIENTS AND METHODS. The Etude Epidemiologique sur les Petits Ages Gestationnels (EPIPAGE) study was a prospective population-based cohort study that included all births occurring between 22 and 32 weeks' gestation and a control group of infants born at 39 to 40 weeks' gestation in 1997 in 9 French regions. Neonatal and obstetrics data were collected at birth. At 5 years of age, sociodemographic status and neuro-developmental and cognitive development of the children, as well as maternal mental well-being, were assessed. The behavioral problems of 1102 very preterm and 375 term singletons without major impairments were studied by using the parent-completed Strengths and Difficulties Questionnaire.RESULTS. Parents of very preterm children reported significantly more behavioral problems, with a twofold higher prevalence compared with term children for hyperactivity/inattention, emotional symptoms, and peer problems. Behavioral problems were associated with low cognitive performance, developmental delay, hospitalizations of the child, young maternal age, and poor maternal mental well-being. Very preterm children were still at higher risk of behavioral problems compared with term children after adjustment for cognitive performance and all others factors.CONCLUSIONS. Behavioral problems were strongly related to cognitive impairment, but very preterm children were still at higher risk even after adjusting for cognitive performance. Early screening for behavioral problems should be encouraged for all very preterm children, and maternal well-being should also be the focus of special attention. Pediatrics 2009; 123: 1485-1492