Adolescent Outcomes of <1000 gram Birth Weight Children

描述（由申请人提供）：本申请要求支持继续我们对极低出生体重（ELBW，<1 kg）对结局的影响的检查。我们对1992-1995年出生的219名ELBW进行了前瞻性随访。一个学校匹配组176正常出生体重（NBW）控制招募8岁。8年的研究结果显示，慢性病和特殊医疗保健需求以及对学习和行为有影响的认知和神经心理缺陷的发生率非常高。这些都增加了家庭的压力和负担。这些儿童已进入青春期，这是一个生理、心理和社会发生巨大变化的时期，对ELBW儿童构成特殊挑战。本申请的主要目的是将纵向随访延长至14岁，以检查ELBW的持续影响以及青春期可能发生的健康、发育和行为的关键变化。我们提出了一个发展的生物心理社会框架，认为后遗症ELBW青春期的结果相比，NBW儿童。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，行为和心理社会调整。该模型探讨了人际关系，包括家庭，同伴和学校的关系作为围产期风险的调解人，以及社会人口和个人因素，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背景变量的关系。我们假设：a）ELBW儿童在健康、神经心理和学习功能以及行为方面的结果将继续低于NBW儿童;对家庭的负面影响; B）ELBW组的慢性疾病和特殊医疗保健需求的高发生率将在青春期增加; c）ELBW相对于NBW的影响将包括社会孤立，焦虑和抑郁症状的增加以及风险承担的减少。ELBW组代表了在美国出生于20世纪90年代的唯一一个学龄儿童。这些发现将为旨在减少或预防不良后果的干预措施提供信息。我们的数据还将为规划和提供新生儿重症监护中幸存的ELBW儿童的服务提供重要信息。

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.