The Research Institute at Nationwide Children's Hospital,Center for Biobehavioral Health, andDepartment of Pediatrics,The Ohio State University,Columbus,Ohio.
Department of Pediatrics,Case Western Reserve University,and Rainbow Babies & Children's Hospital,University Hospitals Cleveland Medical Center,Cleveland,Ohio.
J Int Neuropsychol Soc. 2019 Apr;25(4):362-374. doi: 10.1017/S1355617719000080.
Research on developmental outcomes of preterm birth has traditionally focused on adverse effects. This study investigated the prevalence and correlates of resilience in 146 extremely preterm/extremely low birth weight (EPT/ELBW) children (gestational age <28 weeks and/or birth weight <1000 g) attending kindergarten and 111 term-born normal birth weight (NBW) controls.
Adaptive competence (i.e., "resilience" in the EPT/ELBW group) was defined by scores within grade expectations on achievement tests and the absence of clinically elevated parent ratings of child behavior problems. The "adaptive" children who met these criteria were compared to the "maladaptive" children who did not on child and family characteristics. Additional analyses were conducted to assess the conjoint effects of group (ELBW vs. NBW) and family factors on adaptive competence.
A substantial minority of the EPT/ELBW group (45%) were competent compared to a majority of NBW controls (73%), odds ratio (95% confidence interval)=0.26 (0.15, 0.45), p<.001. Adaptive competence was associated with higher cognitive skills, more favorable ratings of behavior and learning not used to define adaptive competence, and more advantaged family environments in both groups, as well as with a lower rate of earlier neurodevelopmental impairment in the EPT/ELBW group. Higher socioeconomic status and more favorable proximal home environments were associated with competence independent of group, and group differences in competence persisted across the next two school years.
The findings document resilience in kindergarten children with extreme prematurity and highlight the role of environmental factors as potential influences on outcome. (JINS, 2019, 25, 362-374).
对早产儿发育结果的研究传统上侧重于负面效应。本研究调查了在幼儿园就读的 146 名极早产儿/极低出生体重儿（胎龄 <28 周和/或出生体重 <1000 克）和 111 名足月正常出生体重儿（NBW）对照组的韧性流行率和相关因素。
适应性能力（即 EPT/ELBW 组中的“韧性”）通过成就测试中年级期望范围内的分数以及临床显著的父母对儿童行为问题评分来定义。符合这些标准的“适应性”儿童与不符合这些标准的“适应性不良”儿童在儿童和家庭特征方面进行比较。进行了额外的分析，以评估组（ELBW 与 NBW）和家庭因素对适应性能力的联合效应。
与大多数 NBW 对照组（73%）相比，相当一部分 EPT/ELBW 组（45%）具有适应性，优势比（95%置信区间）=0.26（0.15，0.45），p<.001。适应性能力与较高的认知技能、更有利的行为和学习评分（不用于定义适应性能力）以及两组中更有利的家庭环境有关，并且与 EPT/ELBW 组中早期神经发育障碍的发生率较低有关。较高的社会经济地位和更有利的近端家庭环境与适应性有关，与组无关，并且在随后的两个学年中，组间的适应性差异仍然存在。
这些发现证明了极端早产儿在幼儿园阶段的适应能力，并强调了环境因素作为潜在影响结果的作用。（JINS，2019，25，362-374）。
