患有单缝颅缝早闭的学龄儿童的智力和学业功能。
Intellectual and academic functioning of school-age children with single-suture craniosynostosis.
作者信息
Speltz Matthew L, Collett Brent R, Wallace Erin R, Starr Jacqueline R, Cradock Mary Michaeleen, Buono Lauren, Cunningham Michael, Kapp-Simon Kathleen
机构信息
Departments of Psychiatry and Behavioral Sciences and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington;
Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington;
出版信息
Pediatrics. 2015 Mar;135(3):e615-23. doi: 10.1542/peds.2014-1634.
OBJECTIVE
We compared the developmental status of school-age children with single-suture craniosynostosis (case group) and unaffected children (control group). Within the case group we compared the performance of children distinguished by location of suture fusion (sagittal, metopic, unicoronal, lambdoid).
METHODS
We administered standardized tests of intelligence, reading, spelling, and math to 182 case participants and 183 control participants. This sample represented 70% of those tested during infancy before case participants had corrective surgery.
RESULTS
After adjustment for demographics, case participants' average scores were lower than those of control participants on all measures. The largest observed differences were in Full-Scale IQ and math computation, where case participants' adjusted mean scores were 2.5 to 4 points lower than those of control participants (Ps ranged from .002 to .09). Adjusted mean case-control differences on other measures of achievement were modest, although case deficits became more pronounced after adjustment for participation in developmental interventions. Among case participants, 58% had no discernible learning problem (score <25th percentile on a standardized achievement test). Children with metopic, unicoronal, and lambdoid synostosis tended to score lower on most measures than did children with sagittal fusions (Ps ranged from <.001 to .82).
CONCLUSIONS
The developmental delays observed among infants with single-suture craniosynostosis are partially evident at school age, as manifested by lower average scores than those of control participants on measures of IQ and math. However, case participants' average scores were only slightly lower than those of control participants on reading and spelling measures, and the frequency of specific learning problems was comparable. Among case participants, those with unicoronal and lambdoid fusions appear to be the most neurodevelopmentally vulnerable.
目的
我们比较了单缝颅缝早闭患儿（病例组）和未受影响儿童（对照组）的发育状况。在病例组中，我们比较了根据缝融合位置（矢状缝、额缝、单冠状缝、人字缝）区分的儿童的表现。
方法
我们对182例病例参与者和183例对照参与者进行了智力、阅读、拼写和数学的标准化测试。该样本占婴儿期接受测试者的70%，此时病例参与者尚未接受矫正手术。
结果
在对人口统计学因素进行调整后，病例参与者在所有测量指标上的平均得分均低于对照参与者。观察到的最大差异在于全量表智商和数学计算，病例参与者的调整后平均得分比对照参与者低2.5至4分（P值范围为0.002至0.09）。在其他学业成就测量指标上，病例组与对照组的调整后平均差异较小，尽管在对参与发育干预进行调整后，病例组的缺陷变得更加明显。在病例参与者中，58%没有明显的学习问题（在标准化成就测试中得分低于第25百分位）。与矢状缝融合的儿童相比，额缝、单冠状缝和人字缝早闭的儿童在大多数测量指标上得分往往较低（P值范围为<0.001至0.82）。
结论
单缝颅缝早闭婴儿中观察到的发育迟缓在学龄期部分明显，表现为在智商和数学测量指标上的平均得分低于对照参与者。然而，病例参与者在阅读和拼写测量指标上的平均得分仅略低于对照参与者，且特定学习问题的发生率相当。在病例参与者中，单冠状缝和人字缝融合的儿童似乎在神经发育方面最脆弱。
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