Pels A, Knaven O C, Wijnberg-Williams B J, Eijsermans M J C, Mulder-de Tollenaer S M, Aarnoudse-Moens C S H, Koopman-Esseboom C, van Eyck J, Derks J B, Ganzevoort W, van Wassenaer-Leemhuis A G
Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2019 Mar;234:63-70. doi: 10.1016/j.ejogrb.2018.12.041. Epub 2019 Jan 11.
The objective of this study is to explore developmental outcomes at five years after early-onset fetal growth restriction (FGR).
Retrospective data analysis of prospective follow-up of patients of three Dutch centres, who participated in a twenty centre European randomized controlled trial on timing of delivery in early-onset FGR. Developmental outcome of very preterm infants born after extreme FGR is assessed at (corrected) age of five.
Seventy-four very preterm FGR children underwent follow-up at the age of five. Mean gestational age at birth was 30 weeks and birth weight was 910 g, 7% had a Bayley score <85 at two years. Median five years' FSIQ was 97, 16% had a FSIQ < 85, and 35% had one or more IQ scores <85. Motor score ≤ 7 on movement ABC-II (M-ABC-II-NL) was seen in 38%. Absent or reversed end-diastolic flow, gestational age at delivery, birthweight and neonatal morbidity were related to an FSIQ < 85. Any abnormal IQ scale score was related to birthweight, male sex and severity of FGR, and abnormal motor score to male sex and bronchopulmonary dysplasia (BPD).
Overall, median cognitive outcome at five years was within normal range, but 35% of the children had any abnormal IQ score at age five, depending on the IQ measure, and motor impairment was seen in 38% of the children. GA at delivery, birthweight, EDF prior to delivery and neonatal morbidity were the most important risk factors for cognitive outcomes.
本研究旨在探讨早发型胎儿生长受限（FGR）后五年的发育结局。
对三个荷兰中心参与一项关于早发型FGR分娩时机的二十中心欧洲随机对照试验患者的前瞻性随访进行回顾性数据分析。对极重度FGR后出生的极早早产儿在（矫正）五岁时的发育结局进行评估。
74名极早早产FGR儿童在五岁时接受了随访。出生时的平均孕周为30周，出生体重为910克，7%的儿童在两岁时贝利评分<85。五岁时的FSIQ中位数为97，16%的儿童FSIQ<85，35%的儿童有一个或多个智商分数<85。38%的儿童在运动ABC-II（M-ABC-II-NL）上的运动评分≤7。舒张末期血流缺失或反向、分娩时的孕周、出生体重和新生儿发病率与FSIQ<85有关。任何异常的智商量表评分与出生体重、男性性别和FGR的严重程度有关，异常运动评分与男性性别和支气管肺发育不良（BPD）有关。
总体而言，五岁时的认知结局中位数在正常范围内，但35%的儿童在五岁时根据智商测量方法有任何异常智商评分，38%的儿童存在运动障碍。分娩时的孕周、出生体重、分娩前的舒张末期血流和新生儿发病率是认知结局最重要的危险因素。
