Rajput Nitin, McKinlay Chris, Purdie Gordon, Filipovska Julia, Battin Malcolm, Patel Harshad, Tuohy Pat
Department of Paediatrics, Tamworth Base Hospital, Tamworth, New South Wales, Australia.
Liggins Institute, University of Auckland, Auckland, New Zealand.
J Paediatr Child Health. 2018 Mar;54(3):238-246. doi: 10.1111/jpc.13707. Epub 2017 Sep 20.
Very preterm (VPT) children (≤32 weeks) have school readiness difficulties across multiple domains, but routine follow-up is often limited. We assessed the performance of VPT children on the Before School Check (B4SC), a community-based screening programme of school readiness at 4 years of age.
VPT children discharged from Wellington and Auckland Neonatal Intensive Care Units (2005-2009) were compared to a national control cohort born during the same period. Outcome measures included Parental Evaluation of Developmental Status (PEDS), parent and teacher versions of the Strengths and Difficulties Questionnaire (SDQ-P and SDQ-T) and vision and hearing screening, and were related to perinatal and demographic characteristics obtained from the Australia and New Zealand Neonatal Network database.
Of 1105 VPT children, 920 were matched to the B4SC database, of whom 814 (88%) had one or more B4SC screening outcomes recorded. Compared with controls, VPT children were more likely to have abnormal PEDS (odds ratio (OR) = 1.79, 1.53-2.10), SDQ-P (OR = 1.82, 1.49-2.23), SDQ-T (OR = 1.51, 1.10-2.06), vision (OR = 2.00, 1.54-2.60) and hearing (OR = 1.95, 1.65-2.31) screen outcomes. While VPT children with an abnormal screen were more likely to be referred for further assessment, only 34%, 22%, 94% and 51% with abnormal PEDS, SDQ or vision and hearing screen, respectively, had evidence of appropriate referral. School readiness difficulties were significantly associated with birthweight z-score ≤ -1, vaginal delivery, significant cranial ultrasound abnormalities, younger maternal age, higher deprivation neighbourhood and ventilation ≥72 h.
Community-based screening may be useful for identifying VPT children with school readiness difficulties, but low referral rates may limit the effectiveness of such programmes.
极早产儿（胎龄≤32周）在多个领域存在入学准备困难，但常规随访往往有限。我们评估了极早产儿在4岁入学准备社区筛查项目“学前检查”（B4SC）中的表现。
将惠灵顿和奥克兰新生儿重症监护病房出院的极早产儿（2005 - 2009年）与同期出生的全国对照队列进行比较。结果指标包括发育状况家长评估（PEDS）、优势与困难问卷家长版和教师版（SDQ - P和SDQ - T）以及视力和听力筛查，并与从澳大利亚和新西兰新生儿网络数据库获得的围产期和人口统计学特征相关。
在1105名极早产儿中，920名与B4SC数据库匹配，其中814名（88%）有一项或多项B4SC筛查结果记录。与对照组相比，极早产儿更有可能出现PEDS异常（比值比（OR）=1.79，1.53 - 2.10）、SDQ - P异常（OR = 1.82，1.49 - 2.23）、SDQ - T异常（OR = 1.51，1.10 - 2.06）、视力异常（OR = 2.00，1.54 - 2.60）和听力异常（OR = 1.95，1.65 - 2.31）筛查结果。虽然筛查异常的极早产儿更有可能被转诊进行进一步评估，但PEDS、SDQ或视力和听力筛查异常的儿童中，分别只有34%、22%、94%和51%有适当转诊的证据。入学准备困难与出生体重z评分≤ - 1、阴道分娩、明显的颅脑超声异常、母亲年龄较小、贫困程度较高的社区以及通气≥72小时显著相关。
基于社区的筛查可能有助于识别有入学准备困难的极早产儿，但转诊率低可能会限制此类项目的有效性。
