早产儿儿童的认知、运动、行为和学业表现：一项纳入 64061 名儿童的荟萃分析和系统评价。

Cognitive, motor, behavioural and academic performances of children born preterm: a meta-analysis and systematic review involving 64 061 children.

机构信息

Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Multidisciplinary Evidence Synthesis Hub (mEsh), Queen Mary University of London, London, UK.

出版信息

BJOG. 2018 Jan;125(1):16-25. doi: 10.1111/1471-0528.14832. Epub 2017 Oct 11.

DOI:10.1111/1471-0528.14832

PMID:29024294

Abstract

BACKGROUND

Preterm birth may leave the brain vulnerable to dysfunction. Knowledge of future neurodevelopmental delay in children born with various degrees of prematurity is needed to inform practice and policy.

OBJECTIVE

To quantify the long-term cognitive, motor, behavioural and academic performance of children born with different degrees of prematurity compared with term-born children.

SEARCH STRATEGY

PubMed and Embase were searched from January 1980 to December 2016 without language restrictions.

SELECTION CRITERIA

Observational studies that reported neurodevelopmental outcomes from 2 years of age in children born preterm compared with a term-born cohort.

DATA COLLECTION AND ANALYSIS

We pooled individual estimates of standardised mean differences (SMD) and odds ratios (OR) with 95% confidence intervals using a random effects model.

MAIN RESULTS

We included 74 studies (64 061 children). Preterm children had lower cognitive scores for FSIQ (SMD: -0.70; 95% CI: -0.73 to -0.66), PIQ (SMD: -0.67; 95% CI: -0.73 to -0.60) and VIQ (SMD: -0.53; 95% CI: -0.60 to -0.47). Lower scores for preterm children in motor skills, behaviour, reading, mathematics and spelling were observed at primary school age, and this persisted to secondary school age, except for mathematics. Gestational age at birth accounted for 38-48% of the observed IQ variance. ADHD was diagnosed twice as often in preterm children (OR: 1.6; 95% CI: 1.3-1.8), with a differential effect observed according to the severity of prematurity (I = 49.4%, P = 0.03).

CONCLUSIONS

Prematurity of any degree affects the cognitive performance of children born preterm. The poor neurodevelopment persists at various ages of follow up. Parents, educators, healthcare professionals and policy makers need to take into account the additional academic, emotional and behavioural needs of these children.

TWEETABLE ABSTRACT

Adverse effect of preterm birth on a child's neurodevelopment persists up to adulthood.

摘要

背景

早产儿的大脑可能容易出现功能障碍。为了指导实践和制定政策，我们需要了解不同程度早产儿的儿童未来神经发育迟缓的情况。

目的

定量比较不同程度早产儿与足月出生儿童的长期认知、运动、行为和学业表现。

检索策略

从 1980 年 1 月至 2016 年 12 月，我们在 PubMed 和 Embase 上进行了无语言限制的检索。

选择标准

报道了早产儿与足月出生队列儿童 2 岁后神经发育结果的观察性研究。

数据收集与分析

我们使用随机效应模型汇总了标准化均数差（SMD）和比值比（OR）的个体估计值及其 95%置信区间。

主要结果

我们纳入了 74 项研究（64061 名儿童）。早产儿的 FSIQ（SMD：-0.70；95%CI：-0.73 至-0.66）、PIQ（SMD：-0.67；95%CI：-0.73 至-0.60）和 VIQ（SMD：-0.53；95%CI：-0.60 至-0.47）评分均较低。在小学年龄时，早产儿的运动技能、行为、阅读、数学和拼写评分较低，这种情况一直持续到中学年龄，除了数学。出生时的胎龄解释了观察到的智商变异的 38-48%。早产儿被诊断为 ADHD 的可能性是足月出生儿童的两倍（OR：1.6；95%CI：1.3-1.8），且根据早产的严重程度存在差异（I = 49.4%，P = 0.03）。