Thompson Jeffrey R, Carter Randy L, Edwards Allison R, Roth Jeffrey, Ariet Mario, Ross Nancy L, Resnick Michael B
University of Florida, Gainesville, Florida, USA.
Am J Perinatol. 2003 Aug;20(6):321-32. doi: 10.1055/s-2003-42773.
Improving medical treatment of extremely low-birth-weight infants over the last 20 to 30 years resulted in increased survival rates. The developmental sequela of salvaged infants is of great interest to perinatologists. The primary purposes of the current study were to assess the effect of birth weight (BW) on developmental delay or disability (DDD) in the first three years of life and determine whether there is a BW threshold below which all infants should be evaluated to determine if intervention services for children with DDD should be received. Three statewide databases were merged: 1998 Birth Vital Statistics; 1997-1998 Medicaid eligibility files; and 1998-2001 Children's Medical Services' Early Intervention Program (CMS-EIP) data. Infants who died within the first year of life and plural births were excluded. The final dataset consisted of 170,874 records. A child was determined to have a DDD if a developmental delay, or an established condition, such as sensory impairment, genetic, metabolic, neurological, or severe attachment disorders, was diagnosed through a multidisciplinary evaluation. Logistic regression models were used to relate BW to DDD, controlling for sociodemographic, behavioral, and perinatal variables. Adjusted odds ratios (OR) were calculated to describe the effects of BW on DDD. There was a significant effect of BW on DDD (Adjusted OR &equals 97.50, 40.01, 15.84, 3.29, 1.39, 1.00, 1.52 for BW categories 450-749, 750-999, 1000-1499, 1500- 2499, 2500-2999, 3000-4749, 4750-6050 g, respectively). In these categories, 70%, 56%, 36%, 11%, 4%, 3%, and 6% of surviving singleton infants, respectively, suffered a DDD in their first 3 years of life. Four medical, five sociodemographic, and two behavioral factors were significant in addition to BW. An equation for predicting the probability of DDD given these factors was obtained, and its use exemplified. BW is strongly associated with DDD. Over 60% of infants weighing < 1000 g and nearly half (46%) of those weighing < 1500 g at birth are diagnosed with a DDD before 3 years of age. The probability of DDD for a specific infant also varies by sociodemographic, other perinatal, and behavioral factors. The results of this paper suggest that all surviving infants of BW < 1000 g, and perhaps < 1500 g, should be automatically referred for evaluation.
在过去二三十年里，极低出生体重儿的医疗救治水平有所提高，这使得存活率上升。存活婴儿的发育后遗症是围产医学专家极为关注的问题。本研究的主要目的是评估出生体重（BW）对婴儿出生后前三年发育迟缓或残疾（DDD）的影响，并确定是否存在一个BW阈值，低于该阈值的所有婴儿都应接受评估，以确定是否需要接受针对DDD儿童的干预服务。合并了三个全州范围的数据库：1998年出生生命统计数据；1997 - 1998年医疗补助资格档案；以及1998 - 2001年儿童医疗服务早期干预项目（CMS - EIP）数据。排除出生后第一年内死亡的婴儿和多胞胎。最终数据集包含170,874条记录。如果通过多学科评估诊断出发育迟缓或患有既定病症，如感觉障碍（译者注：原文sensory impairment直译为感觉障碍，这里结合语境意译为感官障碍更合适）、遗传、代谢、神经或严重依恋障碍等，则判定该儿童患有DDD。使用逻辑回归模型将BW与DDD关联起来，同时控制社会人口统计学、行为学和围产期变量。计算调整后的优势比（OR）来描述BW对DDD的影响。BW对DDD有显著影响（对于BW类别为450 - 749、750 - 999、1000 - 1499、1500 - 2499、2500 - 2999、3000 - 4749、4750 - 6050克的婴儿，调整后的OR分别为97.50、40.01、15.84、3.29、1.39、1.00、1.52）。在这些类别中，存活的单胎婴儿在出生后前三年分别有70%、56%、36%、11%、4%、3%和6%患有DDD。除BW外，还有四个医学因素、五个社会人口统计学因素和两个行为学因素具有显著性。得到了一个根据这些因素预测DDD概率的方程，并举例说明了其用法。BW与DDD密切相关。超过60%出生体重<1000克的婴儿以及近一半（46%）出生体重<1500克的婴儿在3岁前被诊断患有DDD。特定婴儿患DDD的概率也因社会人口统计学、其他围产期和行为学因素而异。本文结果表明，所有出生体重<1000克、或许<1500克的存活婴儿都应自动转介接受评估。
