Department of Health Sciences, University of Leicester, Leicester LE1 6TP, UK.
BMJ. 2012 Mar 1;344:e896. doi: 10.1136/bmj.e896.
To investigate the burden of later disease associated with moderate/late preterm (32-36 weeks) and early term (37-38 weeks) birth.
Secondary analysis of data from the Millennium Cohort Study (MCS).
Longitudinal study of infants born in the United Kingdom between 2000 and 2002.
18,818 infants participated in the MCS. Effects of gestational age at birth on health outcomes at 3 (n = 14,273) and 5 years (n = 14,056) of age were analysed.
Growth, hospital admissions, longstanding illness/disability, wheezing/asthma, use of prescribed drugs, and parental rating of their children's health.
Measures of general health, hospital admissions, and longstanding illness showed a gradient of increasing risk of poorer outcome with decreasing gestation, suggesting a "dose-response" effect of prematurity. The greatest contribution to disease burden at 3 and 5 years was in children born late/moderate preterm or early term. Population attributable fractions for having at least three hospital admissions between 9 months and 5 years were 5.7% (95% confidence interval 2.0% to 10.0%) for birth at 32-36 weeks and 7.2% (1.4% to 13.6%) for birth at 37-38 weeks, compared with 3.8% (1.3% to 6.5%) for children born very preterm (<32 weeks). Similarly, 2.7% (1.1% to 4.3%), 5.4% (2.4% to 8.6%), and 5.4% (0.7% to 10.5%) of limiting longstanding illness at 5 years were attributed to very preterm birth, moderate/late preterm birth, and early term birth.
These results suggest that health outcomes of moderate/late preterm and early term babies are worse than those of full term babies. Additional research should quantify how much of the effect is due to maternal/fetal complications rather than prematurity itself. Irrespective of the reason for preterm birth, large numbers of these babies present a greater burden on public health services than very preterm babies.
探讨中度/晚期早产儿（32-36 周）和早期足月产儿（37-38 周）相关后期疾病的负担。
对千年队列研究（MCS）数据的二次分析。
对 2000 年至 2002 年期间在英国出生的婴儿进行的纵向研究。
18818 名婴儿参加了 MCS。分析了出生时的胎龄对 3 岁（n=14273）和 5 岁（n=14056）时健康结果的影响。
生长、住院、长期疾病/残疾、喘息/哮喘、使用处方药以及父母对子女健康的评分。
一般健康、住院和长期疾病的指标显示，随着早产程度的降低，不良结局的风险呈梯度增加，提示早产存在“剂量反应”效应。在 3 岁和 5 岁时，对疾病负担贡献最大的是晚期/中度早产或早期足月产儿。9 个月至 5 岁期间至少住院 3 次的人群归因分数为，32-36 周出生为 5.7%（95%置信区间 2.0%至 10.0%），37-38 周出生为 7.2%（1.4%至 13.6%），而极早产（<32 周）出生为 3.8%（1.3%至 6.5%）。同样，5 岁时患有严重长期疾病的 2.7%（1.1%至 4.3%）、5.4%（2.4%至 8.6%）和 5.4%（0.7%至 10.5%）归因于极早产、中晚期早产和早期足月产。
这些结果表明，中度/晚期早产儿和早期足月产儿的健康结局比足月儿差。进一步的研究应该量化母体/胎儿并发症而不是早产本身对其影响的程度。无论早产的原因是什么，这些婴儿都比极早产儿对公共卫生服务造成了更大的负担。
