School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland;
School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Child and Family Research Institute, Vancouver, Canada;
Pediatrics. 2015 Jan;135(1):126-41. doi: 10.1542/peds.2014-1143.
Children who experienced intrauterine growth restriction (IUGR) may be at increased risk for adverse developmental outcomes in early childhood. The objective of this study was to carry out a systematic review of neurodevelopmental outcomes from 6 months to 3 years after IUGR.
PubMed, Embase, PsycINFO, Maternity and Infant Care, and CINAHL databases were searched by using the search terms intrauterine, fetal, growth restriction, child development, neurodevelopment, early childhood, cognitive, motor, speech, language. Studies were eligible for inclusion if participants met specified criteria for growth restriction, follow-up was conducted within 6 months to 3 years, methods were adequately described, non-IUGR comparison groups were included, and full English text of the article was available. A specifically designed data extraction form was used. The methodological quality of included studies was assessed using well-documented quality-appraisal guidelines.
Of 731 studies reviewed, 16 were included. Poorer neurodevelopmental outcomes after IUGR were described in 11. Ten found motor, 8 cognitive, and 7 language delays. Other delays included social development, attention, and adaptive behavior. Only 8 included abnormal Doppler parameters in their definitions of IUGR.
Evidence suggests that children are at risk for poorer neurodevelopmental outcomes following IUGR from 6 months to 3 years of age. The heterogeneity of primary outcomes, assessment measures, adjustment for confounding variables, and definitions of IUGR limits synthesis and interpretation. Sample sizes in most studies were small, and some examined preterm IUGR children without including term IUGR or AGA comparison groups, limiting the value of extant studies.
经历宫内生长受限（IUGR）的儿童在幼儿期可能面临更多的发育不良风险。本研究旨在对 IUGR 后 6 个月至 3 岁的神经发育结局进行系统评价。
使用“宫内、胎儿、生长受限、儿童发育、神经发育、幼儿期、认知、运动、言语、语言”等检索词，检索 PubMed、Embase、PsycINFO、Maternity and Infant Care 和 CINAHL 数据库。符合以下标准的研究纳入：参与者符合生长受限标准，随访时间在 6 个月至 3 年内，方法描述充分，纳入非 IUGR 对照组，且文章全文为英文。使用专门设计的数据提取表。使用经过充分验证的质量评估指南评估纳入研究的方法学质量。
共回顾了 731 项研究，其中 16 项被纳入。11 项研究描述了 IUGR 后的神经发育结局较差，10 项研究发现运动发育迟缓，8 项认知发育迟缓，7 项语言发育迟缓。其他发育迟缓包括社会发展、注意力和适应行为。只有 8 项研究将异常多普勒参数纳入 IUGR 的定义中。
证据表明，儿童在 IUGR 后 6 个月至 3 岁时存在神经发育不良的风险。主要结局、评估测量、混杂因素调整和 IUGR 的定义存在异质性，限制了综合和解释。大多数研究的样本量较小，一些研究仅检查了早产 IUGR 儿童，而没有纳入足月 IUGR 或 AGA 对照组，限制了现有研究的价值。
