No change in neurodevelopment at 11 years after extremely preterm birth
No change in neurodevelopment at 11 years after extremely preterm birth
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DOI：
10.1136/archdischild-2020-320650
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发表时间：
2021-07-01
影响因子：
4.4
通讯作者：
Johnson, Samantha
中科院分区：
文献类型：
--
作者：
Marlow, Neil;Ni, Yanyan;Johnson, Samantha
目的确定1995年和2006年英格兰两组22-25周出生的妇女的学龄结局是否有所改善。设计全国纵向队列研究。对11岁儿童进行校本或家庭评估。2006年英国22-26周出生的EPICure2队列：1031名幸存者中200名的样本进行了评估；112名22-25周出生的孩子的结局与1995年在英国出生的176名来自EPICure队列的孩子进行了比较。每组的课堂对照作为参考人群。主要结果测量：认知和学业成绩的标准化测量与家长报告的其他损伤相结合，以评估整体神经发育状况。结果在11年时，18%的患者出现重度损伤，20%的患者出现中度损伤。在EPICure2中比较22-25周出生的婴儿（n=112）， 26%有严重和21%有中度损伤，而在EPICure中分别为18%和32%。调整后，2006年与1995年相比，中度或重度神经发育障碍的OR为0.76 （95% CI 0.45 ~ 1.31, p=0.32）。智商分数在1995年（平均82.7,SD 18.4）和2006年（81.4,SD 19.2）相似，调整后的平均z-score差异为0.2 SD (95% CI -0.2至0.6)，成就测试分数也是如此。多重归算的使用并没有改变这些发现。结论：1995年至2006年期间护理和生存率的改善与认知或教育结果的改善或神经发育障碍发生率的降低并不平行。
Objective To determine whether improvements in school age outcomes had occurred between two cohorts of births at 22-25 weeks of gestation to women residents in England in 1995 and 2006. Design Longitudinal national cohort studies. Setting School-based or home-based assessments at 11 years of age. Participants EPICure2 cohort of births at 22-26 weeks of gestation in England during 2006: a sample of 200 of 1031 survivors were evaluated; outcomes for 112 children born at 22-25 weeks of gestation were compared with those of 176 born in England during 1995 from the EPICure cohort. Classroom controls for each group acted as a reference population. Main outcome measures Standardised measures of cognition and academic attainment were combined with parent report of other impairments to estimate overall neurodevelopmental status. Results At 11 years in EPICure2, 18% had severe and 20% moderate impairments. Comparing births at 22-25 weeks in EPICure2 (n=112), 26% had severe and 21% moderate impairment compared with 18% and 32%, respectively, in EPICure. After adjustment, the OR of moderate or severe neurodevelopmental impairment in 2006 compared with 1995 was 0.76 (95% CI 0.45 to 1.31, p=0.32). IQ scores were similar in 1995 (mean 82.7, SD 18.4) and 2006 (81.4, SD 19.2), adjusted difference in mean z-scores 0.2 SD (95% CI -0.2 to 0.6), as were attainment test scores. The use of multiple imputation did not alter these findings. Conclusion Improvements in care and survival between 1995 and 2006 are not paralleled by improved cognitive or educational outcomes or a reduced rate of neurodevelopmental impairment.