Child Development Centre, University Children's Hospital Zurich, Zurich, Switzerland. Clinic of Neonatology, University Hospital Zurich, Zurich, Switzerland. Child Psychiatry Unit, University Hospital Aachen, Aachen, Germany.
Dev Med Child Neurol. 2011 Sep;53(9):822-828. doi: 10.1111/j.1469-8749.2011.04024.x. Epub 2011 Jun 27.
We assessed motor and intellectual outcome in triplets at school age and investigated the predictive value of perinatal and demographic factors.
Seventy-one live-born newborn infants (24 triplet pregnancies) were prospectively enrolled at birth. At the age of 6 years, 58 children (31 males, 27 females; mean gestational age 31.2 wks [SD 2.2 wks]; mean birthweight 1622 g [SD 440 g]) returned for a neurodevelopmental examination. A comparison group for triplets born before 32 gestational weeks comprising 26 gestational age-, birthweight-, and sex-matched singletons was also recruited (mean gestational age 30.1 wk [SD 1.5 wk]; mean birthweight 1142 g [SD 210 g]; 12 males, 14 females). The Zurich Neuromotor Assessment was used to examine motor performance, and intellectual abilities were assessed with the Kaufman Assessment Battery for Children (K-ABC).
Motor performance and movement quality in these individuals was significantly reduced compared with the test norms for all motor tasks (p<0.001) other than static balance. The mean values on the Mental Processing Composite (95.3, SD 8.4) and the Achievement Scale (90.1, SD 13.8) of the K-ABC were also lower than those in the test reference (p<0.05 and p<0.01 respectively). Triplets born at less than 32 weeks' gestation showed poorer pure motor and adaptive gross motor performance (both p<0.05) than, but similar intellectual performance to, the gestational age-, birthweight- and sex-matched singletons. Poor outcome was predicted by low socio-economic status and by intertriplet birthweight discordance (both p<0.01).
Triplets were at an increased risk of mild motor and intellectual impairments. This finding is important for tailoring therapeutic interventions for these children and for parental counselling. Very preterm triplets showed similar outcomes to the singleton comparison children, except that they had poorer motor performance. Low socio-economic status was a major risk factor for impaired intellectual development. In addition, birthweight discordance may also be considered a predictor for poor long-term motor and intellectual outcome in triplets.
我们评估了学龄三胞胎的运动和智力发育情况，并探讨了围产期和人口统计学因素的预测价值。
71 例活产新生儿（24 例三胞胎妊娠）在出生时前瞻性入组。6 岁时，58 名儿童（31 名男性，27 名女性；平均胎龄 31.2 周[标准差 2.2 周]；平均出生体重 1622 克[标准差 440 克]）返回进行神经发育检查。还招募了一组在 32 孕周之前出生的三胞胎作为对照，包括 26 名胎龄、出生体重和性别匹配的单胎婴儿（平均胎龄 30.1 周[标准差 1.5 周]；平均出生体重 1142 克[标准差 210 克]；12 名男性，14 名女性）。使用苏黎世神经运动评估来检查运动表现，使用 Kaufman 儿童评估量表（K-ABC）评估智力能力。
与所有运动任务（除静态平衡外）的测试参考值相比，这些个体的运动表现和运动质量明显降低（p<0.001）。K-ABC 的心理加工综合得分（95.3，标准差 8.4）和成就量表得分（90.1，标准差 13.8）也低于测试参考值（分别为 p<0.05 和 p<0.01）。胎龄小于 32 周的三胞胎的纯运动和适应粗大运动表现较差（均为 p<0.05），但智力表现与胎龄、出生体重和性别匹配的单胎婴儿相似。低社会经济地位和三胞胎之间出生体重的差异（均为 p<0.01）是不良结局的预测因素。
三胞胎有轻度运动和智力障碍的风险增加。这一发现对于为这些儿童量身定制治疗干预措施和家长咨询非常重要。非常早产儿的结局与单胎对照儿童相似，只是运动表现较差。低社会经济地位是智力发育受损的主要危险因素。此外，出生体重差异也可能被视为三胞胎长期运动和智力结局不良的预测因素。
