Larroque B
Inserm U149, Unité de Recherches Epidémiologiques en Santé Périnatale et Santé des Femmes, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif Cedex, France.
J Gynecol Obstet Biol Reprod (Paris). 2004 Oct;33(6 Pt 1):475-86. doi: 10.1016/s0368-2315(04)96560-x.
Advances in perinatal care have lead to the survival of an increasing number of children born very premature. The purpose of this review is to discuss findings in the literature regarding long term developmental outcome of infants born prematurely especially for studies with children at least 5 years old, born in the 80's or after, in a context of care with increased use of antenatal corticoids, in utero transfer, and surfactant therapy. Developmental sequelae, which are seen in children older than those presenting severe deficiencies, concerns a greater number of very premature children. They have poorer outcomes than term children or normal birth weight controls for cognitive-neuropsychological skills, school performances and behavior. Long term follow up of these children shows that consequences are still present for adolescents or young adults. There is a gradient of developmental sequelae in children that is inversely related to decreasing gestational age or birth weight. Developmental sequelae are related to neonatal medical complications and social risks factors. Research should be conducted in order to better understand etiology and neuropathological basis of sequelae, and the long term developmental implication of being born very premature and the type of care or intervention which could improve their development. An early and regular follow up by a team specialized in child development should be proposed in order to detect developmental sequelae and propose early intervention.
围产期护理的进步使得越来越多的极早产儿得以存活。本综述的目的是讨论文献中关于早产儿长期发育结局的研究结果,特别是针对80年代及以后出生、至少5岁的儿童,在增加使用产前皮质类固醇、宫内转运和表面活性剂治疗的护理背景下的研究。发育后遗症在年龄大于有严重缺陷儿童的儿童中可见,涉及更多的极早产儿。在认知神经心理技能、学业成绩和行为方面,他们的结局比足月儿或正常出生体重对照儿童更差。对这些儿童的长期随访表明,青少年或年轻成年人仍存在相关后果。儿童发育后遗症存在梯度变化,与胎龄或出生体重的降低呈负相关。发育后遗症与新生儿医学并发症和社会风险因素有关。应开展研究,以更好地理解后遗症的病因和神经病理学基础,以及极早产出生的长期发育影响和可能改善其发育的护理或干预类型。应建议由儿童发育专业团队进行早期和定期随访,以检测发育后遗症并提出早期干预措施。