Burguet A, Monnet E, Roth P, Hirn F, Vouaillat C, Lecourt-Ducret M, Fromentin C, Dornier L, Helias J, Choulot M J, Allemand H, Maillet R, Menget A
Service de réanimation infantile polyvalente et prématurés, CHU Saint-Jacques, Besançon, France.
Arch Pediatr. 2000 Apr;7(4):357-68. doi: 10.1016/s0929-693x(00)88830-2.
To appreciate the impact of prematurity, fetal hypotrophy and familial environment on the neurodevelopmental performances of very premature infants without cerebral palsy at the age of five years.
We followed a regional cohort of 171 very premature infants (< or = 32 weeks of gestation) until they were five years of age. Cognitive functions were tested with the WPPSI test and the development quotient was assessed by the ability to draw a "bonhomme". Twenty-two premature infants suffered from cerebral palsy diagnosed before the age of two years. Another infant had a moderate diplegia at the five-year examination. We had no information for 16 prematures (9.3% of survivors). Twenty-eight premature infants were considered as having no severe disability on phone or mailed contact, and another child had a severe isolated mental retardation. We examined 104/148 infants, and 96/148 survivors without cerebral palsy passed the tests. The cognitive functions of these premature infants are compared to the performances of a control group made up of 108 children born at term > or = 37 weeks, matched for birthplace and single or twin characteristics of the pregnancy.
The values of the different quotients are significantly decreased in the preterm group. The global IQ and the performance IQ are 0.8 SD, verbal IQ is 0.5 SD and the development quotient is 0.4 SD below the values observed in the control group. A performance IQ less than -2 SD for the mean of the control group is observed three times more than in the controls (13.5% vs 3.7%, P < 0.01). Multiple linear regression shows that prematurity explains, independent of hypotrophy and socioeconomic environment, 8% of the variation of the performance IQ (P < 0.01), 2% of the variation of the verbal IQ and 2% of the development quotient (P < 0.05).
The five-year neurologic outcome of the children born prematurely in this regional study is similar to the results observed in regional studies conducted in Europe: 13.4% of the survivors have cerebral palsy, and the cognitive functions of the children with no cerebral palsy are significantly lower than the term control group. Other risk factors such as hypotrophy, which modulates the developmental quotient, and the socioeconomic status, which modulates the verbal IQ, are underlined.
了解早产、胎儿发育迟缓及家庭环境对5岁时无脑瘫的极早产儿神经发育表现的影响。
我们追踪了一个包含171名极早产儿（孕周≤32周）的区域队列，直至他们5岁。使用韦氏学前及初小儿童智力量表（WPPSI）测试认知功能，并通过画“小人”的能力评估发育商。22名早产儿在2岁前被诊断患有脑瘫。另一名婴儿在5岁检查时患有中度双侧瘫。16名早产儿（占存活者的9.3%）我们没有相关信息。通过电话或邮件联系，28名早产儿被认为没有严重残疾，另有一名儿童患有严重的孤立性智力障碍。我们检查了104/148名婴儿，148名无脑瘫的存活者中有96名通过了测试。将这些早产儿的认知功能与一个由108名足月（孕周≥37周）出生的儿童组成的对照组的表现进行比较，对照组在出生地以及妊娠的单胎或双胎特征方面进行了匹配。
早产组不同商数的值显著降低。总体智商和操作智商比对照组低0.8个标准差，言语智商低0.5个标准差，发育商低0.4个标准差。操作智商低于对照组均值-2个标准差的情况在早产组中出现的次数是对照组的3倍（13.5%对3.7%，P<0.01）。多元线性回归显示，早产独立于发育迟缓及社会经济环境，可解释操作智商变异的8%（P<0.01）、言语智商变异的2%以及发育商变异的2%（P<0.05）。
在该区域研究中，早产儿5岁时的神经学结局与在欧洲进行的区域研究结果相似：13.4%的存活者患有脑瘫，无脑瘫儿童的认知功能显著低于足月对照组。强调了其他风险因素，如调节发育商的发育迟缓以及调节言语智商的社会经济地位。
