Peterson Jennifer, Taylor H Gerry, Minich Nori, Klein Nancy, Hack Maureen
Rainbow Babies and Children's Hospital, Case Western Reserve University, Division of Neonatology, Department of Pediatrics, Cleveland, Ohio 44106, USA.
Early Hum Dev. 2006 May;82(5):325-34. doi: 10.1016/j.earlhumdev.2005.09.014. Epub 2005 Dec 19.
Subnormal head circumference (HC) has been associated with poor neurologic and developmental outcomes.
To examine the correlates and consequences of subnormal HC in a cohort of school age, very low birth weight (VLBW, <1,500 g) children. STUDY DESIGN AND OUTCOME MEASURES: We examined developmental outcomes at a mean age of 6.8 years in a cohort of 128 VLBW children born from 1982-1986 and 58 normal birth weight controls. The VLBW cohort included a regional sample of <750 g birth weight children and matched children with 750-1,499 g birth weight. Outcomes included an IQ equivalent, neuropsychological skills, academic achievement, adaptive behavior, and attention problems. HC was defined along a continuum and as subnormal vs. normal. Linear and logistic regressions were employed to determine the effects of HC on the outcomes after controlling for confounding variables.
Thirty one VLBW children (24%) had subnormal HC vs. none of the controls. The VLBW children with subnormal HC differed significantly from the normal HC group in birth weight (748 g vs. 977 g, p<.001), SGA status (52% vs. 27%, p<.05), high neonatal risk (57% vs. 29%, p<.05), and neurosensory impairment (23% vs. 8%, p<.05). Even after taking these risk factors into account, subnormal HC was associated with poorer IQ equivalent, perceptual motor skills, academic achievement, and adaptive behavior. Results were similar after excluding the children with neurosensory impairment.
Subnormal HC is associated with adverse developmental outcomes in VLBW children, independent of other risk factors. Interventions to improve antenatal and postnatal growth may contribute to better school-age outcomes.
头围低于正常水平（HC）与不良的神经和发育结局相关。
研究学龄期极低出生体重（VLBW，<1500 g）儿童队列中HC低于正常水平的相关因素及后果。
我们在一个队列中检查了1982年至1986年出生的128名VLBW儿童及58名正常出生体重对照儿童在平均年龄6.8岁时的发育结局。VLBW队列包括出生体重<750 g儿童的区域样本以及出生体重为750 - 1499 g的匹配儿童。结局包括智商等效值、神经心理技能、学业成绩、适应性行为和注意力问题。HC沿连续区间定义，并分为低于正常水平和正常水平。在控制混杂变量后，采用线性回归和逻辑回归来确定HC对结局的影响。
31名VLBW儿童（24%）的HC低于正常水平，而对照组中无此情况。HC低于正常水平的VLBW儿童在出生体重（748 g对977 g，p<.001）、小于胎龄儿状态（52%对27%，p<.05）、高新生儿风险（57%对29%，p<.05）以及神经感觉障碍（23%对8%，p<.05）方面与HC正常组有显著差异。即使考虑了这些风险因素，HC低于正常水平仍与较差的智商等效值、感知运动技能、学业成绩和适应性行为相关。排除神经感觉障碍儿童后结果相似。
HC低于正常水平与VLBW儿童的不良发育结局相关，独立于其他风险因素。改善产前和产后生长的干预措施可能有助于获得更好的学龄期结局。
