Department of Pediatrics, Lund University, Lund, Sweden.
Pediatrics. 2011 Apr;127(4):e874-82. doi: 10.1542/peds.2010-1821. Epub 2011 Mar 7.
To evaluate the effects of intrauterine growth restriction (IUGR) with absent or reversed end-diastolic blood flow in the umbilical artery and very preterm birth on cognitive outcome at 5 to 8 years of age.
We studied 34 children with IUGR born at a median of 26.9 gestational weeks (GWs) (range: 24-29 GWs) (PT-IUGR), 34 matched preterm appropriate-for-gestational age (PT-AGA) children, and 34 term AGA children (T-AGA) by using the Wechsler Preschool and Primary Scale of Intelligence, Wechsler Intelligence Scale for Children, Strengths and Difficulties Questionnaire, and Brown's attention-deficit disorder (ADD) scales.
The PT-IUGR group had mean (SD) scores on the verbal IQ (VIQ) and full-scale IQ (FSIQ) of 83.8 (17.3) and 78.9 (16.6), respectively, compared with the PT-AGA group, which had scores of 96.0 (14.5) and 90.1 (14.2) (P = .003 and P < .007), and the T-AGA group, which had scores of 101.3 (12) and 102.9 (13.2) (P < .001 and P < 001), respectively. The VIQ difference remained significant after adjustment for parental level of education, gestational age at birth, and neonatal morbidity. Performance IQ (PIQ) did not differ between the PT-IUGR and PT-AGA groups; their mean PIQs were lower than that of the T-AGA group (P < .001). Boys in the PT-IUGR group scored lower than girls in VIQ and FSIQ (P = .005 and .007, respectively). Behavior and ADD scores did not differ between the preterm groups.
Children born very preterm after IUGR have an increased risk for cognitive impairment at early school age compared with children delivered very preterm for other reasons. Differences in cognitive outcome were restricted to boys who may have been especially vulnerable to the influence of IUGR and very preterm birth.
评估脐动脉舒张末期血流缺失或反流的宫内生长受限（IUGR）与极早产儿出生对 5 至 8 岁认知结果的影响。
我们通过使用韦氏学前和小学智力量表、韦氏儿童智力量表、长处和困难问卷以及 Brown 的注意力缺陷障碍（ADD）量表，研究了 34 名中位孕龄 26.9 周（范围：24-29 周）（PT-IUGR）的 IUGR 早产儿、34 名匹配的早产儿适宜胎龄（PT-AGA）和 34 名足月 AGA 儿童。
PT-IUGR 组的言语智商（VIQ）和全量表智商（FSIQ）平均（SD）分数分别为 83.8（17.3）和 78.9（16.6），与 PT-AGA 组相比，PT-AGA 组的分数为 96.0（14.5）和 90.1（14.2）（P=0.003 和 P<0.007），与 T-AGA 组相比，PT-AGA 组的分数为 101.3（12）和 102.9（13.2）（P<0.001 和 P<0.001）。调整父母教育水平、出生时的胎龄和新生儿发病率后，VIQ 差异仍然显著。PT-IUGR 组与 PT-AGA 组的表现智商（PIQ）无差异；他们的平均 PIQ 低于 T-AGA 组（P<0.001）。PT-IUGR 组的男孩在 VIQ 和 FSIQ 中的得分低于女孩（P=0.005 和 P=0.007）。两个早产儿组的行为和 ADD 评分无差异。
与因其他原因早产的儿童相比，IUGR 极早产儿在早期学龄期认知受损的风险增加。认知结果的差异仅限于男孩，他们可能特别容易受到 IUGR 和极早产儿出生的影响。
