McCormick M C, Brooks-Gunn J, Workman-Daniels K, Turner J, Peckham G J
Department of Maternal and Child Health, Harvard School of Public Health, Boston, Mass 02115.
JAMA. 1992;267(16):2204-8.
To assess the effect of improved survival of increasingly premature infants by examining the outcomes at school age of a large group of children born at different birth weights.
Inception cohort.
SETTING/PARTICIPANTS: Participants were selected from two previously studied multisite cohorts: very low-birth-weight (less than or equal to 1500 g) children referred to participating intensive care units and heavier birth-weight children drawn from a stratified random sample of births in geographically defined regions. Follow-up at 8 to 10 years of age was by a combination of telephone interview and home/clinic visits for 65.1% (1868) of those eligible.
The presence or absence of 17 specific conditions, limitations in activities of daily living due to health, mental health (affective health, behavior problems), and, for a subset, IQ scores.
Decreasing birth weight was associated with an increased morbidity for all measures except affective health; those with birth weights of 1500 g or less were more likely to experience multiple health problems. Maternal educational attainment did not influence the association of birth weight with morbidity except for IQ among children whose birth weight was above 1000 g, for which socioeconomic disadvantage worsened the status of all children irrespective of birth weight.
Children born at lower birth weights experience increased morbidity at early school age. These results reinforce the importance of postdischarge, early intervention programs to reduce the risk of these later health problems.
通过研究一大群不同出生体重儿童在学龄期的结局，评估提高越来越早产婴儿存活率的效果。
起始队列研究。
设置/参与者：参与者选自两个先前研究的多中心队列：入住参与研究的重症监护病房的极低出生体重（小于或等于1500克）儿童，以及从地理界定区域分层随机抽取的出生体重较重儿童。对符合条件者中65.1%（1868名）进行8至10岁的随访，采用电话访谈和家访/门诊访视相结合的方式。
17种特定状况的有无、因健康导致的日常生活活动受限、心理健康（情感健康、行为问题），以及部分儿童的智商得分。
除情感健康外，出生体重降低与所有指标的发病率增加相关；出生体重1500克或更低的儿童更易出现多种健康问题。母亲教育程度对出生体重与发病率的关联无影响，但对于出生体重高于1000克的儿童，其智商受影响，社会经济劣势会使所有儿童的状况恶化，无论出生体重如何。
出生体重较低的儿童在学龄早期发病率增加。这些结果强化了出院后早期干预项目对于降低这些后期健康问题风险的重要性。
