Delobel-Ayoub Malika, Kaminski Monique, Marret Stéphane, Burguet Antoine, Marchand Laetitia, N'Guyen Sylvie, Matis Jacqueline, Thiriez Gérard, Fresson Jeanne, Arnaud Catherine, Poher Martine, Larroque Béatrice
Research Unit on Perinatal Health and Women's Health, Villejuif, France.
Pediatrics. 2006 Jun;117(6):1996-2005. doi: 10.1542/peds.2005-2310.
Our goal was to compare the prevalence of behavioral problems between very preterm children and term children at 3 years of age and examine the factors associated with behavioral problems in very preterm children.
We conducted a prospective population-based cohort study: the EPIPAGE (Etude Epidémiologique sur les Petits Ages Gestationnels) study. All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included and compared with a control group of infants born at term. Sociodemographic status, obstetric, and neonatal data were collected at birth and in the neonatal units. At 3 years of age, the behavioral problems of 1228 very preterm singleton children without major neurodisabilities, and 447 term children were studied using the Strengths and Difficulties Questionnaire completed by the parents.
Very preterm children were more likely than controls to have behavioral difficulties. Among very preterm children, several medical conditions were associated with a high total difficulty score: major neonatal cerebral lesions diagnosed by cranial ultrasonographic studies, hospitalization within the last year, poor health, and psychomotor delay. A high birth order and sociodemographic factors such as young maternal age and low educational level of the mother were also identified as risk factors for behavioral difficulties. The differences between very preterm children and controls remained significant after adjustment for sociodemographic characteristics, neonatal complications, and neurodevelopmental status, for a high total difficulties score, hyperactivity, conduct problems, and for peer problems. For emotional problems, the difference was at the limit of significance.
Very preterm children have a higher risk of behavioral problems at 3 years of age compared with term-born children. Health and neurodevelopmental status of the child were significantly associated with behavioral difficulties.
我们的目标是比较极早产儿和足月儿3岁时行为问题的发生率，并研究与极早产儿行为问题相关的因素。
我们开展了一项基于人群的前瞻性队列研究：EPIPAGE（小孕周流行病学研究）研究。纳入了1997年法国9个地区妊娠22至32周出生的所有婴儿，并与足月儿对照组进行比较。在出生时和新生儿病房收集社会人口统计学状况、产科和新生儿数据。3岁时，使用父母填写的长处和困难问卷对1228名无重大神经残疾的极早产单胎儿童和447名足月儿的行为问题进行了研究。
极早产儿比对照组更易出现行为困难。在极早产儿中，几种医学状况与总困难得分高相关：经头颅超声检查诊断的主要新生儿脑损伤、过去一年内住院、健康状况差和精神运动发育迟缓。高出生顺序以及年轻产妇年龄和母亲低教育水平等社会人口统计学因素也被确定为行为困难的危险因素。在对社会人口统计学特征、新生儿并发症和神经发育状况进行调整后，极早产儿与对照组在总困难得分高、多动、品行问题和同伴问题方面的差异仍然显著。对于情绪问题，差异接近显著水平。
与足月儿相比，极早产儿在3岁时出现行为问题的风险更高。儿童的健康和神经发育状况与行为困难显著相关。
