Msall M E, Buck G M, Rogers B T, Merke D, Catanzaro N L, Zorn W A
Department of Pediatrics, Children's Hospital of Buffalo, NY 14209.
J Pediatr. 1991 Oct;119(4):606-14. doi: 10.1016/s0022-3476(05)82415-1.
The purpose of this cohort study was to determine the incidence of and risk factors for major neurodevelopmental impairments among survivors of extreme prematurity. The study cohort comprised 100 infants born between 24 and 28 weeks of gestational age at one tertiary center from 1983 to 1984. Twenty-five infants (25%) died; 75 (75%) survived until follow-up (mean, 60 months). Standardized neurodevelopmental and psychometric assessments were performed in blind fashion on 68 of the 75 surviving children (91% follow-up). Informal assessments (parent, teacher, and physician reports) were obtained instead for seven (9%) children who had relocated outside of the area. Overall, 19 children (25%) had one or more major impairments: mental retardation, 9; cerebral palsy, 4; multiple impairments, 5; and blindness, 1. Despite a high prevalence of impairments, 95% of children (n = 71) were functionally independent [corrected]. Special educational resources were definitely necessary for seven (9%) and possibly needed for 36 (48%) additional children. Univariate analyses revealed four significant risk factors for cerebral palsy: hydrocephalus (relative risk = 12.2), grades III and IV intraventricular hemorrhage (relative risk = 5.8), 5-minute Apgar score lower than 7 (relative risk = 5.7), and bronchopulmonary dysplasia (relative risk = 5.5). Hydrocephalus was the only significant risk factor observed for mental retardation (relative risk = 5.4). Risk factors predicting a need for special education resources included sepsis (relative risk = 24.9), low socioeconomic status (relative risk = 16.3), and nonwhite race (relative risk = 3.0). Thus our data suggest that biomedical factors appear to confer the greatest risk of major impairments; sociodemographic factors appear to have a significant impact on educational risk in extremely premature infants who do not die. Continued follow-up with biomedical and developmental-social interventions appears warranted to decrease the risk of educational underachievement in this population.
这项队列研究的目的是确定极早产儿幸存者中主要神经发育障碍的发生率和风险因素。研究队列包括1983年至1984年在一家三级中心出生的100名孕龄在24至28周之间的婴儿。25名婴儿（25%）死亡；75名（75%）存活至随访（平均60个月）。对75名存活儿童中的68名（随访率91%）进行了标准化神经发育和心理测量评估。另外7名（9%）已搬离该地区的儿童则通过非正式评估（家长、教师和医生报告）获取信息。总体而言，19名儿童（25%）有一项或多项主要障碍：智力迟钝9例；脑瘫4例；多重障碍5例；失明1例。尽管障碍发生率很高，但95%的儿童（n = 71）功能独立[校正后]。7名（9%）儿童绝对需要特殊教育资源，另外36名（48%）儿童可能需要。单因素分析揭示了脑瘫的四个显著风险因素：脑积水（相对风险 = 12.2）、III级和IV级脑室内出血（相对风险 = 5.8）、5分钟阿氏评分低于7分（相对风险 = 5.7）以及支气管肺发育不良（相对风险 = 5.5）。脑积水是观察到的智力迟钝的唯一显著风险因素（相对风险 = 5.4）。预测需要特殊教育资源的风险因素包括败血症（相对风险 = 24.9）、社会经济地位低（相对风险 = 16.3）和非白人种族（相对风险 = 3.0）。因此，我们的数据表明，生物医学因素似乎带来了主要障碍的最大风险；社会人口学因素似乎对未死亡的极早产儿的教育风险有重大影响。继续对生物医学和发育 - 社会干预进行随访似乎有必要，以降低该人群教育成就低下的风险。
