Petrini Joann R, Dias Todd, McCormick Marie C, Massolo Maria L, Green Nancy S, Escobar Gabriel J
Perinatal Data Center, March of Dimes National Office, White Plains, NY 10605, USA.
J Pediatr. 2009 Feb;154(2):169-76. doi: 10.1016/j.jpeds.2008.08.020. Epub 2008 Dec 10.
To assess the risks of moderate prematurity for cerebral palsy (CP), developmental delay/mental retardation (DD/MR), and seizure disorders in early childhood.
Retrospective cohort study using hospitalization and outpatient databases from the Northern California Kaiser Permanente Medical Care Program. Data covered 141 321 children > or =30 weeks born between Jan 1, 2000, and June 30, 2004, with follow-up through June 30, 2005. Presence of CP, DD/MR, and seizures was based on International Classification of Diseases, Ninth Revision codes identified in the encounter data. Separate Cox proportional hazard models were used for each of the outcomes, with crude and adjusted hazard ratios calculated for each gestational age group.
Decreasing gestational age was associated with increased incidence of CP and DD/MR, even for those born at 34 to 36 weeks gestation. Children born late preterm were >3 times as likely (hazard ratio, 3.39; 95% CI, 2.54-4.52) as children born at term to be diagnosed with CP. A modest association with DD/MR was found for children born at 34 to 36 weeks (hazard ratio, 1.25; 95% CI, 1.01-1.54), but not for children in whom seizures were diagnosed.
Prematurity is associated with long-term neurodevelopmental consequences, with risks increasing as gestation decreases, even in infants born at 34 to 36 weeks.
评估中度早产在儿童早期发生脑瘫（CP）、发育迟缓/智力障碍（DD/MR）和癫痫症的风险。
采用北加利福尼亚凯撒医疗保健计划的住院和门诊数据库进行回顾性队列研究。数据涵盖了2000年1月1日至2004年6月30日出生的141321名孕周≥30周的儿童，并随访至2005年6月30日。CP、DD/MR和癫痫症的存在基于在就诊数据中识别的国际疾病分类第九版编码。对每个结局分别使用Cox比例风险模型，计算每个孕周组的粗风险比和调整后风险比。
孕周降低与CP和DD/MR的发病率增加相关，即使是那些孕34至36周出生的儿童。晚期早产出生的儿童被诊断为CP的可能性是足月出生儿童的3倍多（风险比，3.39；95%置信区间，2.54 - 4.52）。孕34至36周出生的儿童与DD/MR存在适度关联（风险比，1.25；95%置信区间，1.01 - 1.54），但癫痫症诊断儿童不存在这种关联。
早产与长期神经发育后果相关，随着孕周减少风险增加，即使是孕34至36周出生的婴儿。
