Korkman Marit, Mikkola Kaija, Ritari Niina, Tommiska Viena, Salokorpi Teija, Haataja Leena, Tammela Outi, Pääkkönen Leena, Olsén Päivi, Fellman Vineta
Department of Psychology, University of Helsinki, Helsinki, Finland.
Dev Neuropsychol. 2008;33(5):637-55. doi: 10.1080/87565640802254471.
The neurocognitive outcome of children born with extremely low birth weight (ELBW) is highly variable due to the complexity of morbidity. So far, no study has compared comprehensive neuropsychological test profiles in groups with different neuromotor status. In a national cohort of ELBW children neuropsychological test profiles were assessed in 4 groups defined according to a neurological examination at 5 years of age: normal neuromotor status (N = 56), motor coordination problems (N = 32), multiple subtle neuromotor signs including both motor coordination problems and deviant reflexes (N = 20), and spastic diplegia (N = 12). The neurocognitive assessment included a test of intelligence, the Wechsler Primary and Preschool Scale of Intelligence-Revised (WPPSI-R) and 14 subtests of attention and executive functions, verbal functions, manual motor functions, visuoconstructional functions and verbal learning (NEPSY). The children with normal neuromotor status performed within the average range; children with motor coordination problems had widespread impairment; and children with spastic diplegia and children with multiple minor neuromotor signs had uneven test profiles with stronger verbal results but weaknesses in attention and executive functions, and in manual motor and visuoconstructional tasks. In conclusion, very preterm children with neuromotor signs, including motor coordination problems, are at risk for neurocognitive impairment, in spite of average intelligence. More impaired children have more irregular test profiles. Follow-up and neuropsychological assessment of very preterm children with minor neuromotor signs are therefore indicated.
由于发病情况复杂，极低出生体重（ELBW）儿的神经认知结局差异很大。到目前为止，尚无研究比较不同神经运动状态组的综合神经心理测试概况。在一个全国性的ELBW儿童队列中，根据5岁时的神经学检查将其分为4组，对各组进行神经心理测试概况评估：神经运动状态正常（N = 56）、运动协调问题（N = 32）、包括运动协调问题和异常反射在内的多种细微神经运动体征（N = 20）以及痉挛性双瘫（N = 12）。神经认知评估包括一项智力测试、韦氏幼儿智力量表修订版（WPPSI-R）以及注意力和执行功能、语言功能、手动运动功能、视觉构建功能和语言学习等14项子测试（NEPSY）。神经运动状态正常的儿童测试结果在平均范围内；有运动协调问题的儿童存在广泛损伤；痉挛性双瘫儿童和有多种轻微神经运动体征的儿童测试概况不均衡，语言结果较好，但在注意力和执行功能以及手动运动和视觉构建任务方面存在弱点。总之，有神经运动体征（包括运动协调问题）的极早产儿，尽管智力平均，但仍有神经认知受损的风险。损伤越严重的儿童测试概况越不规律。因此，对有轻微神经运动体征的极早产儿进行随访和神经心理评估是必要的。
