Rickards A L, Kitchen W H, Doyle L W, Kelly E A
Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia.
Aust Paediatr J. 1989 Jun;25(3):127-9. doi: 10.1111/j.1440-1754.1989.tb01434.x.
When using tests of infant development and intelligence in children born prematurely, the subject's age is commonly corrected for the degree of prematurity. However, there is disagreement: first, on whether this correction should ever be applied, and second, at what age to discontinue the adjustment. In a theoretical model, the difference between corrected and uncorrected scores in early infancy was massive and the difference remained clinically important until the age of 8.5 years in children who were born extremely prematurely. The clinical implications of using corrected or uncorrected scores were then evaluated in 174 very low birthweight children without severe sensorineural disabilities and with paired Bayley Mental Development Index (MDI) and Wechsler Preschool and Primary Scales of Intelligence (WPPSI) full scale scores. Failure to correct for prematurity reduced the mean MDI by 12.1 points but reduced the mean WPPSI by only 4.1 points. The disparity between individual MDI and WPPSI scores increased significantly with decreasing gestational age if uncorrected scores were used (P = 0.015) but not if scores were corrected. Using corrected scores, the MDI correctly predicted the WPPSI category in 86.1% of children (P less than 0.001) but in only 54.6% using uncorrected scores (the difference was not significant). It is suggested that a practical solution to the dilemma is to correct test scores for prematurity in the age range 2-8.5 years recognizing that only in extremely immature infants will uncorrected scores be substantially lower than corrected ones at a later age.
在对早产儿进行婴儿发育和智力测试时，通常会根据早产程度对测试对象的年龄进行校正。然而，存在不同意见：第一，关于是否应进行这种校正；第二，在什么年龄停止调整。在一个理论模型中，极早早产儿在婴儿早期校正分数与未校正分数之间的差异巨大，且这种差异在8.5岁之前在临床上都具有重要意义。然后，对174名出生体重极低、无严重感觉神经性残疾且具有配对的贝利智力发育指数（MDI）和韦氏学前及初小儿童智力量表（WPPSI）全量表分数的儿童，评估使用校正或未校正分数的临床意义。未对早产进行校正使MDI平均分降低了12.1分，但仅使WPPSI平均分降低了4.1分。如果使用未校正分数，个体MDI和WPPSI分数之间的差异会随着胎龄的降低而显著增加（P = 0.015），但校正分数时则不会。使用校正分数时，MDI能正确预测86.1%儿童的WPPSI类别（P小于0.001），但使用未校正分数时仅为54.6%（差异不显著）。建议解决这一困境的实际办法是，在2至8.5岁的年龄范围内对测试分数进行早产校正，同时认识到只有在极不成熟的婴儿中，未校正分数在后期才会明显低于校正分数。
