Hajnal Beatrice Latal, Braun-Fahrländer Charlotte, von Siebenthal Kurt, Bucher Hans U, Largo Remo H
Growth and Development Center, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
Pediatr Neurol. 2005 Feb;32(2):87-93. doi: 10.1016/j.pediatrneurol.2004.09.004.
This study describes time trends for very low birth weight multiple births in relation to very low birth weight singletons. Two cohorts of very low birth weight (less than 1250 gm) children recruited between 1983-85 (cohort 1, n = 115) and 1992-94 (cohort 2, n = 144) were compared. The Bayley Scales of Infant Development and a standardized neurologic examination were administered at 2 years corrected age. Neurodevelopmental outcome did not change between cohort 1 and 2 for singletons. For multiple births, mean Mental Developmental Index increased after adjustment for neonatal risk factors [adjusted mean (standard deviation) 81.8 (11.7) to 96.5 (18.6), analysis of covariance P = 0.007]. The prevalence of cerebral palsy decreased, however not significantly [adjusted odds ratio (95% confidence interval) 0.3 (0.1-1.5), P = 0.14]. The proportion of disease-free survival (no cerebral palsy and no developmental delay) increased for multiple births (7-37%, P = 0.002), but not for singletons. In cohort 2, neurodevelopmental outcome of multiple births was similar to that of singletons. The cognitive outcome of very low birth weight multiple births improved, possibly because of changes in perinatal practice. However, neurodevelopmental outcome was similar to that of very low birth weight singletons who were unaffected by changes in neonatal care with high proportions of motor delay and cerebral palsy.
本研究描述了极低出生体重多胞胎相对于极低出生体重单胞胎的时间趋势。对1983 - 1985年（队列1，n = 115）和1992 - 1994年（队列2，n = 144）招募的两组极低出生体重（小于1250克）儿童进行了比较。在矫正年龄2岁时进行贝利婴儿发育量表和标准化神经学检查。单胞胎在队列1和队列2之间的神经发育结局没有变化。对于多胞胎，在调整新生儿危险因素后，平均智力发育指数有所增加[调整后均值（标准差）从81.8（11.7）增至96.5（18.6），协方差分析P = 0.007]。脑瘫患病率有所下降，但不显著[调整优势比（95%置信区间）0.3（0.1 - 1.5），P = 0.14]。多胞胎无病生存（无脑瘫且无发育迟缓）的比例增加（从7%增至37%，P = 0.002），但单胞胎未增加。在队列2中，多胞胎的神经发育结局与单胞胎相似。极低出生体重多胞胎的认知结局有所改善，可能是由于围产期实践的变化。然而，神经发育结局与未受新生儿护理变化影响的极低出生体重单胞胎相似，运动发育迟缓及脑瘫比例较高。
