Schmid G, Schreier A, Meyer R, Wolke D
Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universitaet, Muenchen, Germany.
Child Care Health Dev. 2011 Jul;37(4):493-502. doi: 10.1111/j.1365-2214.2010.01201.x. Epub 2011 Feb 7.
Infant regulatory problems, that is, excessive crying, feeding and/or sleeping difficulties, are precursors of adverse development. However, the aetiology of regulatory problems is still unclear. The aim of this study was to investigate pre-, peri- and post-natal neurophysiological and psychosocial predictors of single and multiple regulatory problems at 5 months of age.
This prospective longitudinal study included all children born at neonatal risk in a geographically defined area in southern Germany. The data of n = 5093 singleton infants (83.6%) were analysed using crude and multivariate logistic regression analyses. As outcome measures we used single and multiple regulatory problems, that is, crying, feeding and/or sleeping difficulties at 5 months of age, which were assessed via a standardized interview with the parents by study paediatricians as part of a neurodevelopmental examination.
In total, 30.7% of the sample suffered from single or multiple regulatory problems at 5 months. Breastfeeding increased the odds of single sleeping problems 5.12-fold, but decreased the odds of single feeding problems [odds ratio (OR) 0.51; 95% confidence interval (CI) 0.35-0.74]. Very preterm birth was predictive of single feeding (OR 1.79; 95% CI 1.25-2.55) and multiple regulatory problems (OR 2.03; 95% CI 1.19-3.46), and foetal abnormalities increased the odds of single feeding and multiple regulatory problems from 1.53- to 1.64-fold. Family adversity and psychosocial stress factors were associated with single crying and multiple regulatory problems.
Pre-, peri- and post-natal neurophysiological and psychosocial factors are predictive of single and multiple regulatory problems. The results may be useful in terms of early recognition of at risk groups for regulatory problems.
婴儿调节问题，即过度哭闹、喂养和/或睡眠困难，是不良发育的先兆。然而，调节问题的病因仍不清楚。本研究的目的是调查5个月大时单一和多种调节问题的产前、围产期和产后神经生理及心理社会预测因素。
这项前瞻性纵向研究纳入了德国南部一个地理区域内所有有新生儿风险的出生儿童。对n = 5093名单胎婴儿（83.6%）的数据进行了粗逻辑回归分析和多变量逻辑回归分析。作为结局指标，我们使用单一和多种调节问题，即5个月大时的哭闹、喂养和/或睡眠困难，这些是由研究儿科医生在神经发育检查中通过与父母的标准化访谈进行评估的。
总体而言，30.7%的样本在5个月时患有单一或多种调节问题。母乳喂养使单一睡眠问题的几率增加了5.12倍，但降低了单一喂养问题的几率[比值比（OR）0.51；95%置信区间（CI）0.35 - 0.74]。极早产可预测单一喂养问题（OR 1.79；95% CI 1.25 - 2.55）和多种调节问题（OR 2.03；95% CI 1.19 - 3.46），胎儿异常使单一喂养问题和多种调节问题的几率增加了1.53至1.64倍。家庭逆境和心理社会压力因素与单一哭闹和多种调节问题相关。
产前、围产期和产后神经生理及心理社会因素可预测单一和多种调节问题。这些结果可能有助于早期识别调节问题的高危人群。
