Lee Miryoung, Pascoe John M, McNicholas Caroline I
Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
Department of Community Health, Lifespan Health Research Center, Boonshoft School of Medicine, Wright State University, 3171 Research Blvd, Dayton, OH, 45420, USA.
Matern Child Health J. 2017 Jan;21(1):199-207. doi: 10.1007/s10995-016-2109-7.
Objectives The prevalence of extreme prematurity at birth has increased, but little research has examined its impact on developmental outcomes in large representative samples within the United States. This study examined the association of extreme prematurity with kindergarteners' reading skills, mathematics skills and fine motor skills. Methods The early childhood longitudinal study-birth cohort, a representative sample of the US children born in 2001 was analyzed for this study. Early reading and mathematics skills and fine motor skills were compared among 200 extremely premature children (EPC) (gestational age <28 wks or birthweight <1000 g), 500 premature children (PC), and 4300 term children (TC) (≥37wks or ≥2500 g). Generalized linear regression analyses included sampling weights, children's age, race, sex, and general health status, and parental marital status and education among singleton children. Results At age 5 years, EPC were 2.6(95 % CI 1.7-3.8) times more likely to fail build a gate and were 3.1(95 % CI 1.6-5.8) times more likely to fail all four drawing tasks compared to TC (p values <0.001). Fine motor performance of PC (failed to build a gate, 1.3[95 % CI 1.0-1.7]; failed to draw all four shapes, 1.1[95 % CI 0.8-1.6]) was not significantly different from TC. Mean early reading scale score (36.8[SE:1.3]) of EPC was 4.0 points lower than TC (p value < 0.0001) while mean reading score (39.9[SE:1.4]) of PC was not significantly different from TC (40.8[SE:1.1]). Mean mathematics scale score were significantly lower for both EPC (35.5[SE:1.0], p value < 0.001) and PC (39.8[SE:0.8], p value = 0.023) compared to TC (41.0[SE:0.6]). Conclusions for Practice Extreme prematurity at birth was associated with cognitive and fine motor delays at age 5 years. This suggests that based on a nationally representative sample of infants, the biological risk of extreme prematurity persists after adjusting for other factors related to development.
目标 出生时极早产的发生率有所上升，但在美国大型代表性样本中，很少有研究考察其对发育结局的影响。本研究考察了极早产与幼儿园儿童阅读技能、数学技能和精细运动技能之间的关联。方法 本研究分析了儿童早期纵向研究——出生队列，这是2001年出生的美国儿童的代表性样本。对200名极早产儿童（EPC）（胎龄<28周或出生体重<1000克）、500名早产儿童（PC）和4300名足月儿（TC）（≥37周或≥2500克）的早期阅读和数学技能以及精细运动技能进行了比较。广义线性回归分析包括抽样权重、儿童年龄、种族、性别和总体健康状况，以及单胎儿童的父母婚姻状况和教育程度。结果 在5岁时，与足月儿相比，极早产儿童搭建门失败的可能性高2.6倍（95%CI 1.7 - 3.8），四项绘画任务全部失败的可能性高3.1倍（95%CI 1.6 - 5.8）（p值<0.001）。早产儿童的精细运动表现（搭建门失败，1.3[95%CI 1.0 - 1.7]；四项形状全部画不出，1.1[95%CI 0.8 - 1.6]）与足月儿无显著差异。极早产儿童的早期阅读量表平均得分（36.8[标准误：1.3]）比足月儿低4.0分（p值<0.0001），而早产儿童的阅读平均得分（39.9[标准误：1.4]）与足月儿（40.8[标准误：1.1]）无显著差异。与足月儿（41.0[标准误：0.6]）相比，极早产儿童（35.5[标准误：1.0]，p值<0.001）和早产儿童（39.8[标准误：$0.8]，p值=0.0$23）的数学量表平均得分均显著较低。实践结论 出生时的极早产与5岁时的认知和精细运动发育迟缓有关。这表明，基于全国代表性的婴儿样本，在调整其他与发育相关的因素后，极早产的生物学风险依然存在。
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