INSERM, UMR 953, Epidemiological Research in Perinatal Health and Women's and Children Health, Bâtiment de recherche, Hôpital Tenon, Paris, France.
Pediatrics. 2011 Apr;127(4):e883-91. doi: 10.1542/peds.2010-2442. Epub 2011 Mar 7.
To determine whether mild and severe growth restriction at birth among preterm infants is associated with neonatal mortality and cerebral palsy and cognitive performance at 5 years of age and school performance at 8 years of age.
All 2846 live births between 24 and 32 weeks' gestation from 9 regions in France in 1997 were included in a prospective observational study (the EPIPAGE [Étude Epidémiologique sur les Petits Ages Gestationnels] study) and followed until 8 years of age. Infants were classified as "small-for-gestational-age" (SGA) if their birth weight for gestational age was at the <10th centile, "mildly-small-for-gestational-age" (M-SGA) if birth weight was at the ≥ 10th centile and <20th centile, and "appropriate-for-gestational-age" (AGA) if birth weight was at the ≥ 20th centile.
Among the children born between 24 and 28 weeks' gestation, the mortality rate increased from 30% in the AGA group to 42% in the M-SGA group and to 62% in the SGA group (P < .01). Birth weight was not significantly associated with any cognitive, behavioral, or motor outcomes at the age of 5 or any school performance outcomes at 8 years. For the children born between 29 and 32 weeks' gestation, SGA children had a higher risk for mortality (adjusted odds ratio [aOR]: 2.79 [95% confidence interval (CI): 1.50-5.20]), minor cognitive difficulties (aOR: 1.73 [95% CI: 1.12-2.69]), inattention-hyperactivity symptoms (aOR: 1.78 [95% CI: 1.10-2.89]), and school difficulties (aOR: 1.74 [1.07-2.82]) compared with AGA children. Being born M-SGA was associated with an increased risk for minor cognitive difficulties (aOR: 1.87 [95% CI: 1.24-2.82]) and behavioral difficulties (aOR: 1.66 [95% CI: 1.04-2.62]).
In preterm children, growth restriction was associated with mortality, cognitive and behavioral outcomes, as well as school difficulties.
确定早产儿出生时轻度和重度生长受限是否与新生儿死亡率以及 5 岁时脑瘫和认知表现以及 8 岁时的学业成绩有关。
1997 年，法国 9 个地区的 24 至 32 周龄的所有 2846 例活产儿均纳入前瞻性观察研究（EPIPAGE [胎儿小龄研究]研究），并随访至 8 岁。如果婴儿的出生体重与其胎龄的第 10 百分位数相比处于<10 百分位数，则将其归类为“小于胎龄儿”（SGA）；如果出生体重处于第 10 百分位数和第 20 百分位数之间，则将其归类为“轻度小于胎龄儿”（M-SGA）；如果出生体重处于第 20 百分位数以上，则将其归类为“适于胎龄儿”（AGA）。
在 24 至 28 周龄出生的儿童中，AGA 组的死亡率从 30%上升至 M-SGA 组的 42%，再上升至 SGA 组的 62%（P<.01）。出生体重与 5 岁时的任何认知、行为或运动结果或 8 岁时的任何学业成绩均无显著相关性。对于 29 至 32 周龄出生的儿童，SGA 儿童的死亡率风险更高（校正比值比[aOR]：2.79[95%置信区间（CI）：1.50-5.20]），存在轻微认知困难（aOR：1.73[95%CI：1.12-2.69]）、注意力不集中-多动症状（aOR：1.78[95%CI：1.10-2.89]）和学业困难（aOR：1.74[1.07-2.82]）的风险高于 AGA 儿童。M-SGA 出生与存在轻微认知困难（aOR：1.87[95%CI：1.24-2.82]）和行为困难（aOR：1.66[95%CI：1.04-2.62]）的风险增加有关。
在早产儿中，生长受限与死亡率、认知和行为结果以及学业困难有关。
