Suikkanen Julia, Miettola Satu, Heinonen Kati, Vääräsmäki Marja, Tikanmäki Marjaana, Sipola Marika, Matinolli Hanna-Maria, Järvelin Marjo-Riitta, Räikkönen Katri, Hovi Petteri, Kajantie Eero
Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki and Oulu, Finland.
Children's Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Pediatr Res. 2021 Jan;89(1):198-204. doi: 10.1038/s41390-020-0851-4. Epub 2020 Mar 19.
This study examines cognitive functioning in adults born across the range of prematurity with appropriate or small for gestational age (SGA) birth weight compared with full-term controls.
ESTER Preterm Birth Study participants without severe disabilities, comprising 133 early preterm (<34 weeks, 17% SGA), 241 late preterm (34 + 0-36 + 6 weeks, 13% SGA), and 348 full-term subjects, performed the Cogstate® test at a mean age of 23.3 (SD = 1.2) years. Subtests measured paired associate learning, psychomotor function, executive function, spatial memory efficiency, visual memory, attention, working memory, visual learning, and emotional cognition. Data were analyzed with linear regression, full models adjusted for prenatal and postnatal factors and socioeconomic position.
Early preterm, late preterm, and full-term participants showed similar abilities in almost all subtests. Early preterm participants had 0.6 fewer moves/10 s (95% CI: -1.0; -0.2, full model) and late preterm and SGA participants had 1.3 fewer moves/10 s (95% CI: -2.1; -0.4) than full-term controls in the Groton Maze Learning Test, indicating weaker spatial memory efficiency.
Adults born across the range of prematurity on average lack major defects in cognitive abilities. Cognitive problems may persist to adulthood only among those born the smallest: very preterm or preterm and SGA.
Although preterm birth is a risk for the developing brain, adults born preterm as a group showed similar cognitive performance to their full-term peers. Children born preterm across gestational ages show defects in cognitive domains. With a supportive environment, many of them have the potential to catch up with those born at term. The unfavorable effect of late preterm birth on cognitive functions in childhood may not persist to adulthood; in this study, adults born late preterm showed similar cognitive functioning to adults born full-term. The deficits in cognitive function in adults born preterm detected by earlier studies mainly concern those born the smallest, i.e., very preterm or preterm and small for gestational age.
本研究调查了与足月儿对照组相比，不同早产程度且出生体重正常或小于胎龄（SGA）的成年人的认知功能。
“酯类物质与早产研究”的参与者无严重残疾，包括133名极早早产儿（<34周，17%为SGA）、241名晚期早产儿（34⁺⁰-36⁺⁶周，13%为SGA）和348名足月儿，他们在平均年龄23.3（标准差=1.2）岁时进行了Cogstate®测试。子测试测量了配对联想学习、心理运动功能、执行功能、空间记忆效率、视觉记忆、注意力、工作记忆、视觉学习和情绪认知。数据采用线性回归分析，完整模型对产前和产后因素以及社会经济地位进行了调整。
极早早产儿、晚期早产儿和足月儿在几乎所有子测试中表现出相似的能力。在格罗顿迷宫学习测试中，极早早产儿每10秒的移动次数比足月儿对照组少0.6次（95%置信区间：-1.0；-0.2，完整模型），晚期早产儿和SGA参与者每10秒的移动次数比足月儿对照组少1.3次（95%置信区间：-2.1；-0.4），表明空间记忆效率较弱。
不同早产程度出生的成年人平均在认知能力方面没有重大缺陷。认知问题可能仅在出生时体重最轻的人群中持续到成年：极早早产儿或早产且SGA。
尽管早产是发育中大脑的一个风险因素，但作为一个群体，早产出生的成年人与足月儿同龄人表现出相似的认知表现。不同孕周早产出生的儿童在认知领域存在缺陷。在支持性环境下，他们中的许多人有潜力赶上足月儿出生的儿童。晚期早产对儿童认知功能的不利影响可能不会持续到成年；在本研究中，晚期早产出生的成年人与足月儿出生的成年人表现出相似的认知功能。早期研究发现早产出生的成年人认知功能缺陷主要涉及出生时体重最轻的人群，即极早早产儿或早产且小于胎龄儿。
