Adolescent Outcomes of <1000 gram Birth Weight Children

描述（由申请人提供）：本申请要求支持我们继续研究极低出生体重（ELBW,<1kg）对结果的影响。我们对219名1992-1995年出生的ELBW进行了前瞻性随访。在8岁时招募了176名正常出生体重（NBW）对照的学校匹配组。研究结果显示，8岁儿童患有慢性病、需要特殊医疗保健、认知和神经心理缺陷的比例非常高，这对学习和行为都有影响。这些都增加了家庭压力和负担。孩子们已经进入青春期，这是一个生理、心理和社会发生巨大变化的时期，对弱旅儿童构成了特殊的挑战。本应用程序的主要目的是将纵向随访延长至14岁，以检查低体重的持续影响以及青春期可能发生的健康、发育和行为方面的关键变化。我们提出了一个发展的生物心理社会框架，该框架考虑了与NBW儿童相比，ELBW对青春期结果的后遗症。较高的围产期风险（主要是脑和肺损伤）预计会导致较差的学业成绩、行为和社会心理适应。该模型考察了人际环境，包括家庭、同伴和学校关系作为围产期风险的中介，以及社会人口统计学和个人因素（如性别和种族）的调节作用。我们还计划研究结果的纵向变化及其与上下文变量的关系。我们假设：a) ELBW儿童在健康、神经心理和学业功能以及行为方面的结果将继续比NBW儿童差；以及对家庭的负面影响，b)在青少年时期，慢性疾病和特殊保健需求的高发率将增加；c)将出现的低死亡率相对于低死亡率的影响将包括增加社会孤立、焦虑和抑郁症状以及减少冒险行为。ELBW群体代表了美国仅有的90后被跟踪到上学年龄的孩子。研究结果将为旨在减少或预防不良后果的干预措施提供信息。我们的数据还将为在新生儿重症监护中存活下来的低出生体重儿童提供规划和提供服务所需的重要信息。

DESCRIPTION (provided by applicant): This application requests support to continue our examination of the effects of of extremely low birth weight (ELBW,<1kg) on outcomes. We have prospectively followed 219 ELBW born 1992-1995 since birth. A school matched group of 176 normal birth weight (NBW) controls were recruited at age 8 years. Results of the study at 8 years reveal very high rates of chronic conditions and special health care needs as well as cognitive and neuropsychologic deficits that have implications for learning and behavior. These result in increased family stress and burden. The children have since entered adolescence, a period of extraordinary biological, psychological and social change that pose special challenges to ELBW children. The major objective of this application is to extend the longitudinal follow up to age 14 years in order to examine the continuing impact of ELBW and the critical changes in health,development and behavior that may occur during adolescence. We present a developmental biopsychosocial framework which considers the sequelae of ELBW on outcomes of adolescence when compared to NBW children. Higher perinatal risk (mainly brain and lung injury) is predicted to result in poorer academic achievement, behavior and psychosocial adjustment. The model examines interpersonal contexts including family, peer and school relationships as mediators of perinatal risk, as well as the moderating effects of sociodemographic and intrapersonal factors such as gender and ethnicity. We also plan to examine the longitudinal changes in outcomes and their relationship to the contextual variables. We hypothesize that a) ELBW children will continue to have poorer outcomes than NBW children in health, neuropsychologic and academic function, and behavior; and negative impact on the family, b) The high rates of chronic disorders and special health care needs of the ELBW group will increase during adolescence; c) Effects of ELBW relative to NBW that will emerge will include increase in social isolation, symptoms of anxiety and depression, and diminished risk taking. The ELBW group represents the only such children followed to school age in the USA who were born in the 1990's. The findings will inform interventions designed to lessen or prevent adverse outcomes. Our data will also provide important information needed for the planning and provision of services for ELBW children who survive neonatal intensive care.