Telethon Kids Institute, The University of Western Australia, Perth, Australia.
Department of Neonatology and Paediatrics, Joondalup Health Campus, Perth, Australia; School of Paediatrics and Child Health, University of Western Australia, Perth, Australia; School of Public Health, Curtin University, Perth, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia.
J Pediatr. 2019 Dec;215:90-97.e1. doi: 10.1016/j.jpeds.2019.07.056. Epub 2019 Sep 4.
To describe the long-term neurodevelopmental and cognitive outcomes for children born preterm.
In this retrospective cohort study, information on children born in Western Australia between 1983 and 2010 was obtained through linkage to population databases on births, deaths, and disabilities. For the purpose of this study, disability was defined as a diagnosis of intellectual disability, autism, or cerebral palsy. The Kaplan-Meier method was used to estimate the probability of disability-free survival up to age 25 years by gestational age. The effect of covariates and predicted survival was examined using parametric survival models.
Of the 720 901 recorded live births, 12 083 children were diagnosed with disability, and 5662 died without any disability diagnosis. The estimated probability of disability-free survival to 25 years was 4.1% for those born at gestational age 22 weeks, 19.7% for those born at 23 weeks, 42.4% for those born at 24 weeks, 53.0% for those born at 25 weeks, 78.3% for those born at 28 weeks, and 97.2% for those born full term (39-41 weeks). There was substantial disparity in the predicted probability of disability-free survival for children born at all gestational ages by birth profile, with 5-year estimates of 4.9% and 10.4% among Aboriginal and Caucasian populations, respectively, born at 24-27 weeks and considered at high risk (based on low Apgar score, male sex, low sociodemographic status, and remote region of residence) and 91.2% and 93.3%, respectively, for those at low risk (ie, high Apgar score, female sex, high sociodemographic status, residence in a major city).
Apgar score, birth weight, sex, socioeconomic status, and maternal ethnicity, in addition to gestational age, have pronounced impacts on disability-free survival.
描述早产儿的长期神经发育和认知结果。
在这项回顾性队列研究中，通过与出生、死亡和残疾人口数据库进行链接，获取了 1983 年至 2010 年期间在西澳大利亚出生的儿童的信息。在本研究中，残疾定义为智力残疾、自闭症或脑瘫的诊断。使用 Kaplan-Meier 方法估计按胎龄计算至 25 岁时无残疾生存的概率。使用参数生存模型检查协变量和预测生存的影响。
在记录的 720901 例活产中，有 12083 例儿童被诊断为残疾，5662 例死亡且无任何残疾诊断。胎龄为 22 周时，无残疾生存至 25 岁的估计概率为 4.1%；胎龄为 23 周时，为 19.7%；胎龄为 24 周时，为 42.4%；胎龄为 25 周时，为 53.0%；胎龄为 28 周时，为 78.3%；胎龄为 39-41 周时，为 97.2%。按出生特征，所有胎龄出生的儿童无残疾生存的预测概率存在很大差异，在胎龄为 24-27 周且被认为是高危（基于低阿普加评分、男性、低社会经济地位和居住在偏远地区）的土著和白人群体中，5 年的估计值分别为 4.9%和 10.4%，而在低危（即高阿普加评分、女性、高社会经济地位、居住在主要城市）的儿童中，分别为 91.2%和 93.3%。
阿普加评分、出生体重、性别、社会经济地位和母亲种族，除胎龄外，对无残疾生存有显著影响。
