Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, VA, United States.
Early Hum Dev. 2011 Feb;87(2):115-9. doi: 10.1016/j.earlhumdev.2010.11.010. Epub 2010 Dec 4.
late-preterm (LPT) birth accounts for a majority of preterm deliveries and until recently was considered low risk for poor cognitive outcome. Previously, we reported deficits in complicated LPT (cLPT) preschoolers (neonatal intensive care unit [NICU]-admitted).
to extend our prior study by comparing cognitive outcome in cLPT and uncomplicated LPT (uLPT; NICU non-admitted) preschoolers.
single center retrospective cohort study of 118 LPT children born in 2004-2006 at 35-36 weeks of gestation; 90 cLPT and 28 uLPT, compared with 100 term-born (≥ 37 weeks of gestation and ≥ 2500 g) participants.
a well-standardized measure of general conceptual ability (GCA), the Differential Ability Scales, Second Edition.
cLPT participants had average mean performances but significantly poorer GCA, Nonverbal Reasoning, and Spatial scores than term-born children, and higher rates of Nonverbal Reasoning and Spatial impairment; uLPT did not differ from TERM. Combined LPT males were at eightfold greater risk than term-born males for nonverbal deficit, and at sevenfold greater risk for GCA impairment than LPT females.
finding greater risk of cognitive deficit in those NICU-admitted due to clinical instability or birth weight < 2 kg compared with non-admitted preschoolers indicates that neonatal morbidities contribute to subtle cognitive deficits detectable at young age, with male gender an additive risk factor. LPT gestational age alone is an insufficient predictor of long-term neurocognitive outcome. Further study should elucidate salient etiologies for early emerging cognitive weaknesses and suggest appropriate interventions to prepare at-risk LPT preschoolers for elementary school entry.
晚期早产儿（LPT）分娩占早产儿分娩的大多数，直到最近，LPT 被认为是认知结局不良的低风险因素。此前，我们报告了患有复杂晚期早产儿（cLPT，即新生儿重症监护病房（NICU）收治）的学龄前儿童认知缺陷。
通过比较患有复杂晚期早产儿（cLPT）和非复杂晚期早产儿（uLPT，即未被 NICU 收治）的学龄前儿童的认知结局，扩展我们之前的研究。
这是一项单中心回顾性队列研究，纳入了 2004 年至 2006 年在 35-36 孕周分娩的 118 名 LPT 儿童；其中 90 名为 cLPT，28 名为 uLPT，并与 100 名足月产（≥37 孕周且≥2500g）的参与者进行比较。
使用经过充分标准化的一般概念能力（GCA）测量工具，即《差异能力量表》第二版。
cLPT 组参与者的平均表现处于平均水平，但 GCA、非言语推理和空间得分显著低于足月产儿童，且非言语推理和空间受损的发生率更高；uLPT 与足月产儿童无差异。合并的 LPT 男性非言语缺陷的风险比足月产男性高 8 倍，GCA 损伤的风险比 LPT 女性高 7 倍。
与非住院的学龄前儿童相比，因临床不稳定或出生体重<2kg 而被收治于 NICU 的晚期早产儿认知缺陷的风险更高，这表明新生儿发病率会导致可在幼儿时期检测到的细微认知缺陷，而男性是一个附加的风险因素。单纯的晚期早产儿胎龄并不能充分预测长期神经认知结局。进一步的研究应阐明早期出现的认知弱点的显著病因，并为有风险的晚期早产儿进入小学做好适当的干预准备。
