Hopp Crista A, Baron Ida Sue
a Fairfax Neonatal Associates at Inova Children's Hospital , Falls Church , VA , USA.
b Independent Private Practice , Potomac , MD , USA.
Clin Neuropsychol. 2017 Feb;31(2):471-486. doi: 10.1080/13854046.2016.1224802. Epub 2016 Oct 5.
Children delivered at the edge of viability are at greatest risk of medical and neuropsychological disability, their adverse outcomes overshadowing extremely preterm survivors with more optimal outcomes. We aimed to describe an exceptionally early-born extremely preterm (EEEP) preschooler whose neurobiological, familial, and socioeconomic factors likely influenced her unexpected cognitive resilience.
Baby G was a 3-years 10-months-old, English-speaking, Caucasian, singleton girl born weighing 435 g at 22 weeks' gestation to well-educated married parents. Neonatal complications of extremely premature birth included sepsis, severe respiratory distress syndrome, patent ductus arteriosus requiring ligation, necrotizing enterocolitis not requiring surgical intervention, and retinopathy of prematurity. Intellectual and neuropsychological testing was administered.
Baby G performed age-appropriately in nearly all domains and did not exhibit intellectual deficits. Her general conceptual ability was above average for both her chronological and adjusted ages. She had below average performance on tests of motor function, working memory, and delayed recall of spatial locations. Standardized parental behavioral questionnaires indicated no concern in emotional or attentional functioning except in relation to mental shifting capacity and signs of anxiety.
Report of persistent adverse neurodevelopmental/neuropsychological disabilities following EEEP birth is a counterpoint to the more optimal outcomes in some vulnerable EEEP survivors. This case emphasizes that decisions about aggressive resuscitation and prognostication for infants born EEEP may be enhanced by consideration of individual variability, and of pertinent medical, socioeconomic, and sociodemographic variables that may be more predictive of neuropsychological outcomes than birth weight and gestational age.
在可存活边缘出生的儿童面临医学和神经心理残疾的风险最大，他们的不良结局掩盖了结局更佳的极早早产儿幸存者。我们旨在描述一名极早早产的学龄前儿童，其神经生物学、家庭和社会经济因素可能影响了她出人意料的认知恢复力。
G宝宝是一名3岁10个月大、讲英语、白种人、单胎女孩，孕22周时出生，体重435克，父母为受过良好教育的已婚人士。极早早产的新生儿并发症包括败血症、严重呼吸窘迫综合征、需要结扎的动脉导管未闭、无需手术干预的坏死性小肠结肠炎以及早产儿视网膜病变。进行了智力和神经心理测试。
G宝宝在几乎所有领域的表现都符合年龄水平，未表现出智力缺陷。她的一般概念能力在实际年龄和校正年龄方面均高于平均水平。她在运动功能、工作记忆和空间位置延迟回忆测试中的表现低于平均水平。标准化的父母行为问卷显示，除了心理转换能力和焦虑迹象外，在情绪或注意力功能方面没有问题。
极早早产儿出生后持续存在不良神经发育/神经心理残疾的报告与一些脆弱的极早早产儿幸存者的更佳结局形成对比。该病例强调，考虑个体差异以及可能比出生体重和胎龄更能预测神经心理结局的相关医学、社会经济和社会人口统计学变量，可能会改进对极早早产儿积极复苏和预后的决策。
