Neonatal Follow-Up Program, Children's and Women's Health Centre of British Columbia, Vancouver, BC, Canada.
Dev Psychobiol. 2012 May;54(4):383-400. doi: 10.1002/dev.20597. Epub 2011 Aug 23.
The majority of children who are born very preterm escape major impairment, yet more subtle cognitive and attention problems are very common in this population. Previous research has linked infant focused attention during exploratory play to later cognition in children born full-term and preterm. Infant focused attention can be indexed by sustained decreases in heart rate (HR). However there are no preterm studies that have jointly examined infant behavioral attention and concurrent HR response during exploratory play in relation to developing cognition. We recruited preterm infants free from neonatal conditions associated with major adverse outcomes, and further excluded infants with developmental delay (Bayley Mental Development Index [MDI < 70]) at 8 months corrected age (CA). During infant exploratory play at 8 months CA, focused attention and concurrent HR response were compared in 83 preterm infants (born 23-32 weeks gestational age [GA]) who escaped major impairment to 46 full-term infants. Focused attention and HR response were then examined in relation to Bayley MDI, after adjusting for neonatal risk. MDI did not differ by group, yet full-term infants displayed higher global focused attention ratings. Among the extremely preterm infants born <29 weeks, fewer days on mechanical ventilation, mean longest focus, and greater HR deceleration during focused attention episodes, accounted for 49% of adjusted variance in predicting concurrent MDI. There were no significant associations for later-born gestational age (29-32 weeks) or full-term infants. Among extremely preterm infants who escape major impairment, our findings suggest unique relationships between focused attention, HR deceleration, and developing cognition.
大多数极早产儿并未出现严重损伤，但该人群仍存在许多认知和注意力方面的轻微问题。先前的研究表明，婴儿在探索性游戏中的专注注意力与足月和早产儿后期的认知能力有关。婴儿的专注注意力可以通过心率（HR）的持续下降来衡量。但是，没有针对极早产儿的研究同时检查了探索性游戏中婴儿的行为注意力和并发 HR 反应与发展认知之间的关系。我们招募了没有与严重不良后果相关的新生儿疾病的极早产儿，并进一步排除了在 8 个月校正年龄（CA）时患有发育迟缓（贝利心理发育指数[MDI<70]）的婴儿。在 8 个月 CA 的婴儿探索性游戏期间，比较了 83 名极早产儿（出生 23-32 周胎龄[GA]）的专注注意力和并发 HR 反应，这些婴儿未出现严重损伤，与 46 名足月婴儿进行了比较。在调整了新生儿风险后，将专注注意力和 HR 反应与贝利 MDI 进行了检查。组间 MDI 无差异，但足月婴儿的整体专注注意力评分较高。在出生胎龄<29 周的极早产儿中，机械通气天数较少、最长注视时间较长、专注注意力时 HR 减速幅度较大，这三个因素占预测同期 MDI 的调整方差的 49%。对于出生胎龄较晚（29-32 周）或足月婴儿，没有显著相关性。在未出现严重损伤的极早产儿中，我们的研究结果表明，专注注意力、HR 减速与发展认知之间存在独特的关系。
