EPICure@19 - the extremely preterm young adult

EPICure研究成立于1995年。英国和爱尔兰所有妊娠20至25周的新生儿都是在10个月内确定的。4004例分娩中有309例存活儿童，他们在2岁半、6岁和11岁时接受了随访。这项研究的信息已被用于为极早产儿制定一系列政策和治疗方案。鉴于11岁时残疾、学习问题、呼吸问题和心理障碍的发生率仍然很高，以及其他更成熟的同龄人提出青春期可能是一个追赶期，我们建议在19岁时重新评估受试者。我们需要这样做的原因是，看看他们的发展是否已经赶上，并评估我们定义的呼吸功能和心血管发育变化的长期影响，这可能对他们的成年生活产生重要的长期影响。考虑到研究中年轻人的独立性，我们将在位于伦敦中心的研究中心安排预约。这将使我们能够进行更好的评估，包括脑部MR扫描。我们将评估以下功能领域：认知、执行功能（注意力、信息处理）、记忆、行为、呼吸功能和血管僵硬度以及感觉阈值。我们的MRI扫描将使我们能够使用最先进的分析将结构和功能测量与这些结果联系起来。此外，我们还将对每个孩子进行生活方式访谈。这些评估的重要性有几个方面：我们将评估儿童在他们向成年过渡时的身体表现，这是评估过早出生对生长，肺部和血管影响的最佳时间，并确定我们童年对这些的评估有多准确;第二，我们可以评估我们对儿童时期认知和执行能力的评估有多大的预测性，或者在青少年时期有多大程度的追赶;第三，我们可以找出成年生活中哪些是重要的关键结果，并回顾我们已经收集的早期生活指标，并建议更好地集中目标，采取干预措施，以改善年轻人的结果。

The EPICure study was established in 1995. All births between 20 and 25 weeks of gestation across the United Kingdom and Ireland were identified in a 10-month period. There were 309 surviving children from 4004 births, who have been followed up at 2 1/2, 6 and 11 years of age. The information from this study has been used to derive a range of policy and treatment options for extremely preterm babies. In view of the findings at 11y of continuing high rates of disability, learning problems, respiratory problems and psychological disturbances, and the suggestion from other more mature cohorts that adolescence may be a period of catch up, we propose to re-evaluate the subjects as young adults at 19 years. The reasons we need to do this are to see whether there has been catch up in terms of their development and to evaluate the longer-term effect of changes we have defined in respiratory function and cardiovascular development, which may have important long-term consequences for their adult life. Given the independence of the young people in the study we will arrange an appointment at the Study centre, based at UCL in Central London. This will allow us to carry out better assessments including a brain MR Scan.We will evaluate the following areas of functioning: cognition, executive function (attention, processing of information), memory, behaviour, respiratory function and blood vessel stiffness, and sensory thresholds. Our MRI scan will allow us to relate structural and functional measures to these outcomes using state-of-the-art analyses. In addition we will undertake a lifestyle interview with each child.The importance of these evaluations is several fold: we will be assessing children at the peak of their physical performance as they transition to adult life making this the best time to assess the effects of being born so early on growth, lungs and blood vessels and to work out how accurate our childhood assessments of these were; secondly we can evaluate how predictive our assessments of cognitive and executive performance were in childhood, or to what extent there is catch up over the teenage years; thirdly we can work out which are the key outcomes in adult life that matter and look back at the early life measures we have already collected and suggest better focused targeting of interventions to improve the young adult outcomes.