Hack M, Breslau N, Weissman B, Aram D, Klein N, Borawski E
Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH.
N Engl J Med. 1991 Jul 25;325(4):231-7. doi: 10.1056/NEJM199107253250403.
We tested the hypothesis that very-low-birth-weight (less than 1.5 kg) infants with perinatal growth failure whose head size is not normal by eight months of age (corrected for prematurity) have significantly poorer growth and neurocognitive abilities at school age than very-low-birth-weight children with a normal head size at eight months. We also hypothesized that these differences would persist even after control for major neurologic impairment and perinatal and sociodemographic risk factors.
We have followed a cohort of very-low-birth-weight children since their birth during the period 1977 to 1979. At eight to nine years of age 249 children were evaluated with a neurologic examination and tests of intelligence; receptive and expressive language skills; speech, reading, mathematics, and spelling aptitude; visual and fine motor abilities; and behavior. Ages were corrected for premature birth.
Among these 249 very-low-birth-weight children, head size was subnormal (less than the mean -2 SD for age) at birth in 30 (12 percent), at term in 57 (23 percent), and at eight months in 33 (13 percent). As compared with the 216 children with normal head sizes, the 33 children with subnormal head sizes at the age of eight months had significantly lower mean birth weights (1.1 vs. 1.2 kg) and higher neonatal risk scores (71 vs. 53) and at the age of eight years had a higher incidence of neurologic impairment (21 percent vs. 8 percent) and lower IQ scores (mean verbal, 84 vs. 98). Even among the children without neurologic abnormalities, a subnormal head size at eight months of age was predictive of poorer verbal and performance IQ scores at eight years of age; lower scores for receptive language, speech, reading, mathematics, and spelling; and a higher incidence of hyperactivity. In multiple regression analyses to control for socioeconomic and neonatal risk factors, intrauterine growth failure, birth weight, and neurologic impairment, a subnormal head size at eight months of age had an independently adverse effect on IQ and on scores for receptive language, speech, reading, and spelling.
In very-low-birth-weight infants, perinatal growth failure, as evidenced by a subnormal head circumference at eight months of age, is associated with poor cognitive function, academic achievement, and behavior at eight years of age.
我们检验了以下假设：出生体重极低（低于1.5千克）且有围产期生长发育迟缓的婴儿，若其在8个月大时（已校正早产因素）头围不正常，那么在学龄期其生长发育及神经认知能力显著低于8个月大时头围正常的极低出生体重儿童。我们还假设，即便在控制了主要神经功能损害以及围产期和社会人口统计学风险因素之后，这些差异仍会存在。
自1977年至1979年，我们对一组极低出生体重儿童进行了跟踪随访。在这些儿童8至9岁时，对249名儿童进行了神经学检查以及智力测试；接受性和表达性语言技能测试；言语、阅读、数学和拼写能力测试；视觉和精细运动能力测试；以及行为测试。年龄已校正早产因素。
在这249名极低出生体重儿童中，出生时头围低于正常（低于年龄均值减2个标准差）的有30名（12%），足月时头围低于正常的有57名（23%），8个月时头围低于正常的有33名（13%）。与216名头围正常的儿童相比，8个月时头围低于正常的33名儿童出生时平均体重显著更低（1.1千克对1.2千克），新生儿风险评分更高（71对53），8岁时神经功能损害发生率更高（21%对8%），智商得分更低（平均语言智商，84对98）。即使在无神经异常的儿童中，8个月时头围低于正常也预示着8岁时语言智商和操作智商得分更低；接受性语言、言语、阅读、数学和拼写得分更低；多动发生率更高。在控制社会经济和新生儿风险因素、宫内生长发育迟缓、出生体重及神经功能损害的多元回归分析中，8个月时头围低于正常对智商以及接受性语言、言语、阅读和拼写得分有独立的不利影响。
在极低出生体重婴儿中，8个月时头围低于正常所证明的围产期生长发育迟缓与8岁时的认知功能差、学业成绩及行为有关。
