Chan E, Leong P, Malouf R, Quigley M A
National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
Royal Children's Hospital, Parkville, Vic., Australia.
Child Care Health Dev. 2016 May;42(3):297-312. doi: 10.1111/cch.12320. Epub 2016 Feb 10.
Children born before full term (39-41 weeks' gestation) are at increased risk of adverse cognitive outcomes. Risk quantification is important as late-preterm (LPT; 34-36 weeks) and early-term (ET; 37-38 weeks) births are common.
This review analyses the effect of LPT and ET births on long-term cognitive and educational outcomes. The primary outcome was general cognitive ability. Secondary outcomes included verbal/non-verbal intelligence quotient, subject-specific school performance and special educational needs. The search strategy included Medline and Embase from January 1975 to June 2013. Eligible studies investigated specified outcomes and included suitable gestational age participants assessed at 2 years and older. Outcome measures and socio-demographic descriptors were extracted, and data meta-analysed where possible.
Eight studies compared ET birth with full-term birth. Fourteen studies compared LPT birth with either term birth (>37 weeks, n = 12 studies) or full-term birth (39-41 weeks, n = 2 studies). Substantial between-study heterogeneity existed. LPT and ET children underperformed in most outcomes compared with their term/full-term counterparts, respectively. For example, LPT children had an increased risk of lower general cognitive ability (adjusted risk ratio 1.38 [95% confidence interval 1.06-1.79]), and full-term children performed 5% of a standard deviation higher (z-score 0.05 [0.02, 0.08]) than ET children. Poorer outcomes persist into adulthood; term cohorts performed 5% of a standard deviation higher than LPT cohorts (z-score 0.05 [0.04, 0.07]), and full-term cohorts performed 3% of a standard deviation higher than ET cohorts (z-score 0.03 [0.02, 0.04]).
This review critically examines the knowledge around long-term cognitive outcomes of LPT and ET births, demonstrating multiple, small, adverse differences between LPT/ET and term/full-term births.
早产（妊娠39 - 41周）出生的儿童出现不良认知结果的风险增加。由于晚期早产（LPT；34 - 36周）和早期足月产（ET；37 - 38周）很常见，风险量化很重要。
本综述分析了晚期早产和早期足月产对长期认知和教育结果的影响。主要结果是一般认知能力。次要结果包括言语/非言语智商、特定学科的学业成绩和特殊教育需求。检索策略包括1975年1月至2013年6月的Medline和Embase。符合条件的研究调查了特定结果，并纳入了在2岁及以上进行评估的合适孕周参与者。提取了结果测量指标和社会人口学描述符，并在可能的情况下对数据进行荟萃分析。
八项研究比较了早期足月产与足月产。十四项研究比较了晚期早产与足月产（孕周>37周，n = 12项研究）或足月产（39 - 41周，n = 2项研究）。研究间存在显著的异质性。与足月/足月儿相比，晚期早产和早期足月儿在大多数结果上表现较差。例如，晚期早产儿童一般认知能力较低的风险增加（调整风险比1.38 [95%置信区间1.06 - 1.79]），足月儿的表现比早期足月儿高出标准差的5%（z分数0.05 [0.02, 0.08]）。较差的结果持续到成年期；足月队列的表现比晚期早产队列高出标准差的5%（z分数0.05 [0.04, 0.07]），足月队列的表现比早期足月队列高出标准差的3%（z分数0.03 [0.02, 0.04]）。
本综述批判性地审视了有关晚期早产和早期足月产长期认知结果的知识，表明晚期早产/早期足月产与足月/足月儿之间存在多个微小的不良差异。
