van de Bor Margot, den Ouden Lya
Department of Pediatrics, University of Nijmegen Medical Center, Nijmegen, The Netherlands.
Semin Perinatol. 2004 Aug;28(4):295-303. doi: 10.1053/j.semperi.2004.08.007.
Long-term sequelae of preterm birth have been studied extensively up until the age of 5 to 8 years. However, the cognitive development of adolescents born preterm has received limited attention. The objective of this study is to determine school performance in adolescents born very preterm. We have followed up a cohort of 484 infants born before 32 weeks of gestation in whom cranial ultrasound was routinely and systematically performed. School performance was assessed in the surviving adolescents at 14 years of age. The outcome variable divided the adolescents into three groups: (1) normal, (2) slow learners, and (3) special education. School performance data were obtained from 278 of 304 surviving adolescents; 129 performed normally, while 107 were slow learners, and 42 needed special education. From the unadjusted odds ratios for the need of special education by the various perinatal factors, only the odds ratio for periventricular-intraventricular hemorrhage was significantly associated (2.56, 95% confidence interval 1.17-4.86). Logistic regression analysis revealed that, after correction for possible confounding factors, the odds ratios for special education were significantly higher for adolescents with all grades of periventricular-intraventricular hemorrhage. Less than 50% of adolescents born before 32 weeks gestation perform normally in school. Periventricular-intraventricular hemorrhage, including the lower grades,does have an unfavorable additional effect on school performance.
早产的长期后遗症在5至8岁之前已得到广泛研究。然而，早产出生青少年的认知发展受到的关注有限。本研究的目的是确定极早产出生青少年的学业表现。我们对一组484名妊娠32周前出生的婴儿进行了随访，这些婴儿均常规且系统地接受了头颅超声检查。在这些存活至14岁的青少年中评估其学业表现。结果变量将青少年分为三组：（1）正常，（2）学习缓慢者，（3）需要特殊教育者。学业表现数据来自304名存活青少年中的278名；129名表现正常，107名是学习缓慢者，42名需要特殊教育。从各种围产期因素导致需要特殊教育的未调整比值比来看，只有脑室周围-脑室内出血的比值比有显著相关性（2.56，95%置信区间1.17 - 4.86）。逻辑回归分析显示，在对可能的混杂因素进行校正后，所有等级脑室周围-脑室内出血的青少年接受特殊教育的比值比显著更高。妊娠32周前出生的青少年中，不到50%在学校表现正常。脑室周围-脑室内出血，包括较低等级的出血，确实对学业表现有不利的额外影响。
