Hee Chung Estefani, Chou Jesse, Brown Kelly A
Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, MI, USA.
Transl Pediatr. 2020 Feb;9(Suppl 1):S3-S8. doi: 10.21037/tp.2019.09.10.
Over the past several decades, improvements in technology in the Neonatal Intensive Care Unit (NICU) have led to improved survival of preterm infants. Some studies have found that premature infants are at higher risk of behavioral problems, motor and sensory abnormalities, developmental delay, and poorer academic performance, while other studies have found no significant difference.
A literature search was conducted through PubMed for articles published between January 2018 and September 2019. Studies that concentrated on preterm infants with relatively uncomplicated NICU courses and without extensive medical interventions were selected.
Historically, preterm infants have been found to be at increased risk for the inattentive subtype of attention deficit hyperactivity disorder (ADHD), depression, anxiety, autism spectrum disorder (ASD), avoidant personality, and anti-social personality, when compared to full term infants. However, some studies found that this difference between the two groups decrease as they enter adolescence and adulthood. Preterm infants are at increased risk for language, cognitive, sensory and motor deficits. Greater gestational age (GA) at birth and higher birth weight is associated with a lower risk of developmental delay. Cohort studies focusing on motor development showed that the degree of impairment decreased over time. Adverse childhood experiences (ACEs) have a negative correlation on multiple domains of development. The overall outcome of these infants may be influenced by socioeconomic status (SES), neonatal morbidities, demographics and parental education. Hearing and vision deficits are relatively infrequent among premature infants. A significant risk factor for hearing impairment involves the use of ototoxic agents such as gentamicin and infants with a patent ductus arteriosus (PDA).
Preterm infants are at higher risk of adverse neurodevelopmental outcomes when compared to their full-term counter parts. However, in recent years it appears that rates of certain neurologic and developmental conditions are occurring in rates lower than historically noted. Premature individuals with possible developmental or mental health concerns should be identified early on so that interventions can be implemented immediately. Those meeting developmental milestone should continue to be monitored closely as deficits may develop later.
在过去几十年中，新生儿重症监护病房（NICU）技术的进步提高了早产儿的存活率。一些研究发现，早产儿出现行为问题、运动和感觉异常、发育迟缓以及学业成绩较差的风险较高，而其他研究则未发现显著差异。
通过PubMed对2018年1月至2019年9月发表的文章进行文献检索。选择了专注于NICU病程相对简单且未接受广泛医疗干预的早产儿的研究。
从历史上看，与足月儿相比，早产儿患注意力缺陷多动障碍（ADHD）注意力不集中亚型、抑郁症、焦虑症、自闭症谱系障碍（ASD）、回避型人格和反社会人格的风险增加。然而，一些研究发现，两组之间的这种差异在进入青春期和成年期时会减小。早产儿出现语言、认知、感觉和运动缺陷的风险增加。出生时胎龄（GA）越大、出生体重越高，发育迟缓的风险越低。专注于运动发育的队列研究表明，损伤程度会随着时间的推移而降低。儿童期不良经历（ACEs）与多个发育领域呈负相关。这些婴儿的总体结局可能受社会经济地位（SES）、新生儿疾病、人口统计学和父母教育的影响。早产儿中听力和视力缺陷相对较少。听力障碍的一个重要风险因素涉及使用庆大霉素等耳毒性药物以及患有动脉导管未闭（PDA）的婴儿。
与足月儿相比，早产儿出现不良神经发育结局的风险更高。然而，近年来，某些神经和发育疾病的发生率似乎低于历史记录。应尽早识别可能存在发育或心理健康问题的早产儿，以便立即实施干预措施。达到发育里程碑的早产儿应继续密切监测，因为后期可能会出现缺陷。
