L Orton Jane, McGinley Jennifer L, Fox Lisa M, Spittle Alicia Jane
Neonatal Services, Royal Women's Hospital, Locked Bag 300, Parkville 3052, Australia.
Department of Physiotherapy, School of Health Sciences, University of Melbourne, Carlton, Australia.
Early Hum Dev. 2015 Dec;91(12):689-94. doi: 10.1016/j.earlhumdev.2015.09.012. Epub 2015 Oct 27.
This study examined the rates of follow-up for a cohort of extremely preterm (EP -<28weeks gestation) and/or extremely low birthweight (ELBW -<1000g) children at two years with related perinatal and geographical factors. The secondary aim was to determine the rates of developmental delay and disability.
A retrospective review of two year follow-up data for all EP and/or ELBW infants born in a large tertiary neonatal hospital over a two year period was undertaken. Neurodevelopmental outcome was assessed using the Bayley Scales of Infant and Toddler Development Scale - 3rd edition (Bayley-III) and neurosensory disability was assessed by a paediatrician using a standard proforma. Rates of delay (composite score≥1SD below mean) were determined using the Bayley-III test norms and a local cohort normative group. Attrition rates and reasons for loss to follow-up were determined.
Only 50% (109/219) of eligible children participated in the follow-up. The follow-up rate for children engaged in an ongoing research project was excellent at 98% (58/59), however it was only 32% (51/160) for children following the clinical pathway. The main reason for not attending the follow-up was loss of contact. Factors associated with attendance included a lower gestation, sepsis and living in the metropolitan areas. The rates of delay in this cohort were greater with reference to local cohort normative data compared to Bayley-III test norms with an overall rate of delay of 72% (95%CI, 63% to 81%) compared to 38% (95%CI, 29% to 50%).
Follow-up of EP/ELBW infants to two years is an important part of clinical care, however the high rate of attrition in routine clinical follow-up and consequent difficulty in accurately determining rates of delay highlight challenges for centres providing ongoing care.
本研究调查了一组极早产儿（EP - 妊娠<28周）和/或极低出生体重儿（ELBW - <1000g）在两岁时的随访率以及相关围产期和地理因素。次要目的是确定发育迟缓及残疾的发生率。
对一家大型三级新生儿医院在两年期间出生的所有EP和/或ELBW婴儿的两年随访数据进行回顾性分析。使用贝利婴幼儿发展量表第三版（Bayley-III）评估神经发育结局，由儿科医生使用标准表格评估神经感觉残疾情况。根据Bayley-III测试标准和当地队列的标准组确定发育迟缓率（综合评分低于平均值≥1个标准差）。确定失访率及失访原因。
仅有50%（109/219）符合条件的儿童参与了随访。参与一项正在进行的研究项目的儿童随访率极佳，为98%（58/59），然而遵循临床路径的儿童随访率仅为32%（51/160）。未参加随访的主要原因是失去联系。与参与随访相关的因素包括孕周较低、败血症以及居住在大都市地区。与Bayley-III测试标准相比，参照当地队列标准数据，该队列的发育迟缓率更高，总体发育迟缓率为72%（95%置信区间，63%至81%），而Bayley-III测试标准下为38%（95%置信区间，29%至50%）。
对EP/ELBW婴儿进行至两岁的随访是临床护理的重要组成部分，然而常规临床随访中的高失访率以及准确确定发育迟缓率的后续困难凸显了为持续护理提供服务的中心所面临的挑战。
