Clinical Neuropsychology Section, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Emma Children's Hospital AMC, Amsterdam, The Netherlands.
Arch Dis Child Fetal Neonatal Ed. 2018 Jul;103(4):F322-F330. doi: 10.1136/archdischild-2017-312916. Epub 2017 Aug 28.
Advances in neonatal healthcare have resulted in decreased mortality after preterm birth but have not led to parallel decreases in morbidity. Academic performance provides insight in the outcomes and specific difficulties and needs of preterm children.
To study academic performance in preterm children born in the antenatal steroids and surfactant era and possible moderating effects of perinatal and demographic factors.
PubMed, Web of Science and PsycINFO were searched for peer-reviewed articles. Cohort studies with a full-term control group reporting standardised academic performance scores of preterm children (<37 weeks of gestation) at age 5 years or older and born in the antenatal steroids and surfactant era were included. Academic test scores and special educational needs of preterm and full-term children were analysed using random effects meta-analysis. Random effects meta-regressions were performed to explore the predictive role of perinatal and demographic factors for between-study variance in effect sizes.
The 17 eligible studies included 2390 preterm children and 1549 controls. Preterm children scored 0.71 SD below full-term peers on arithmetic (p<0.001), 0.44 and 0.52 SD lower on reading and spelling (p<0.001) and were 2.85 times more likely to receive special educational assistance (95% CI 2.12 to 3.84, p<0.001). Bronchopulmonarydysplasia explained 44% of the variance in academic performance (p=0.006).
Preterm children born in the antenatal steroids and surfactant era show considerable academic difficulties. Preterm children with bronchopulmonarydysplasia are at particular risk for poor academic outcome.
新生儿医疗保健的进步降低了早产儿的死亡率，但并没有导致发病率的平行下降。学业成绩可以深入了解早产儿的结局以及他们的具体困难和需求。
研究在产前类固醇和表面活性剂时代出生的早产儿的学业表现，以及围产期和人口统计学因素的可能调节作用。
在 PubMed、Web of Science 和 PsycINFO 上搜索同行评议文献。纳入了在产前类固醇和表面活性剂时代出生、有全期对照组、报告 5 岁及以上早产儿（<37 孕周）标准化学业成绩评分的队列研究。使用随机效应荟萃分析分析早产儿和全期儿童的学业测试成绩和特殊教育需求。进行随机效应荟萃回归，以探讨围产期和人口统计学因素对效应大小的研究间差异的预测作用。
17 项符合条件的研究纳入了 2390 名早产儿和 1549 名对照。早产儿在算术上比全期儿童低 0.71 个标准差（p<0.001），在阅读和拼写上低 0.44 和 0.52 个标准差（p<0.001），接受特殊教育援助的可能性高 2.85 倍（95%CI 2.12 至 3.84，p<0.001）。支气管肺发育不良解释了学业成绩差异的 44%（p=0.006）。
在产前类固醇和表面活性剂时代出生的早产儿表现出相当大的学业困难。患有支气管肺发育不良的早产儿学业成绩不良的风险特别高。
