Department of Psychology, Wayne State University.
Department of Psychiatry, Neuropsychology Program, Children's Hospital.
Neuropsychology. 2011 Sep;25(5):666-678. doi: 10.1037/a0023895.
The neuropsychological outcome of chronic lung disease (CLD) in the very preterm (VP) infant may be determined by a process involving chronic hypoxia, with superimposed acute hypoxic episodes, in the developing brain. We wished to study the differences in quality of outcome between VP preschoolers with and without history of the most common form of CLD in the preterm infant, bronchopulmonary dysplasia (BPD). We also examined the strength of association between BPD severity and neuropsychological outcome, with degree of severity defined according to the National Institute of Child Health and Human Development (NICHD) National Heart, Lung and Blood Institute (NHLBI) Workshop categorical ranking scheme (Jobe & Bancalari, 2001) or in accord with dimensional views of severity of respiratory illness.
We evaluated the intellectual, language, and motor outcomes of 156, predominantly middle-class preschoolers with history of VP birth, with (n = 80) or without (n = 76) BPD. We used supplemental oxygen requirement or need for mechanical ventilation as indirect indexes of respiratory dysfunction.
Following adjustment for potentially confounding sociodemographic variables and perinatal medical risk factors, we found no group differences in neuropsychological outcome based on categorical ranking of BPD severity. However, continuous measures of BPD severity accounted for a unique portion of the variance in fine motor performance (η²p = .05), while patent ductus arteriosus, a risk marker or antecedent of BPD, explained a unique portion of the variance in both receptive language (η²p = .048), and gross motor (η²p = .061) function.
A significant, yet circumscribed, association was demonstrated between neonatal hypoxic risk, in the VP infant, and neuropsychological outcome assessed in the preschool years.
慢性肺部疾病（CLD）在极早产儿（VP）婴儿中的神经心理学结果可能是由发育中大脑的慢性缺氧过程决定的，伴有叠加的急性缺氧发作。我们希望研究 VP 学龄前儿童中有无最常见的早产儿 CLD 形式——支气管肺发育不良（BPD）之间的结局质量差异。我们还检查了 BPD 严重程度与神经心理学结局之间的关联强度，严重程度根据国立儿童健康与人类发展研究所（NICHD）国家心脏、肺和血液研究所（NHLBI）工作组分类排名方案（Jobe 和 Bancalari，2001 年）或根据呼吸疾病严重程度的维度观点来定义。
我们评估了 156 名主要来自中产阶级的 VP 出生后学龄前儿童的智力、语言和运动结局，其中（n=80）有 BPD，或（n=76）无 BPD。我们使用补充氧气需求或机械通气需求作为呼吸功能障碍的间接指标。
在调整潜在的混杂社会人口学变量和围产期医疗风险因素后，我们发现基于 BPD 严重程度的分类排名，神经心理学结局没有组间差异。然而，BPD 严重程度的连续测量解释了精细运动表现的独特部分方差（η²p=0.05），而动脉导管未闭，BPD 的风险标志物或前兆，解释了接受性语言（η²p=0.048）和粗大运动（η²p=0.061）功能的独特部分方差。
在 VP 婴儿中，新生儿缺氧风险与学龄前评估的神经心理学结局之间存在显著但有限的关联。
