Cheong Jeanie L Y, Anderson Peter J, Burnett Alice C, Roberts Gehan, Davis Noni, Hickey Leah, Carse Elizabeth, Doyle Lex W
Neonatal Services and
Premature Infant Follow-Up Program, Royal Women's Hospital, Melbourne, Australia.
Pediatrics. 2017 Jun;139(6). doi: 10.1542/peds.2016-4086.
Survival of extremely preterm (EP; <28 weeks' gestation) infants has increased over the last 2 decades. Equivalent reductions in developmental morbidity in early childhood have not been consistently reported. The aim of this study was to determine trends in neurodevelopmental outcomes at 8 years of age of children born EP (22-27 completed weeks' gestation) over the past 2 decades.
Population-based cohorts of all EP survivors born in the state of Victoria, Australia in 1991-1992, 1997, and 2005 were recruited at birth. At 8 years of age, general intelligence (IQ), academic achievement, and neurosensory status were assessed. Major neurosensory disability was defined as any of moderate or severe cerebral palsy, IQ <-2 SD relative to term controls, blindness, or deafness.
Rates of major neurosensory disability were similar in all eras (1991-1992, 18%; 1997, 15%; 2005, 18%), as were rates of IQ <-2 SD, cerebral palsy, blindness, and deafness. Mean scores for IQ were similar across eras, but there was some evidence that scores for academic achievement were lower in 2005 than in 1997, and the odds of having academic problems were higher in 2005 than in both earlier eras. These outcomes were not explained by differences in known perinatal care or sociodemographic variables between eras.
Contrary to expectations, rates of major neurosensory disability have not improved, and academic performance is poorer at early school age in 2005 than in earlier eras for EP children born in the state of Victoria, Australia.
在过去20年中，极早产儿（孕周＜28周）的存活率有所提高。但幼儿期发育性疾病发病率并未随之出现相应程度的下降，这一情况尚无一致报道。本研究旨在确定过去20年中孕周为22 - 27周的极早产儿8岁时神经发育结局的变化趋势。
选取1991 - 1992年、1997年和2005年在澳大利亚维多利亚州出生的所有极早产儿幸存者为基于人群的队列研究对象，在其出生时纳入研究。在8岁时，评估其一般智力（智商）、学业成绩和神经感觉状态。主要神经感觉障碍定义为中度或重度脑瘫、相对于足月儿对照组智商＜-2标准差、失明或失聪中的任何一种。
各时期主要神经感觉障碍发生率相似（1991 - 1992年为18%；1997年为15%；2005年为18%），智商＜-2标准差、脑瘫、失明和失聪的发生率也相似。各时期智商平均得分相似，但有证据表明2005年学业成绩得分低于1997年，且2005年出现学业问题的几率高于之前两个时期。这些结果无法用各时期已知的围产期护理或社会人口统计学变量差异来解释。
与预期相反，在澳大利亚维多利亚州出生的极早产儿中，主要神经感觉障碍发生率并未改善，且2005年学龄早期的学业表现比早期更差。
