低出生体重儿童的社会决定因素对认知能力的预测。
Prediction of Cognitive Ability With Social Determinants in Children of Low Birth Weight.
机构信息
Lisa M. Blair, PhD, RNC-NIC, is Postdoctoral Scholar, Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington. Jodi L. Ford, PhD, RN, is Associate Professor, The Ohio State University College of Nursing, Columbus. P. Cristian Gugiu, PhD, was Assistant Professor, The Ohio State University College of Education and Human Ecology, Columbus, at the time of the study completion and is now in private practice. Rita H. Pickler, PhD, RN, FAAN, is FloAnn Sours Easton Endowed Professor of Child and Adolescent Health and Director of PhD and MS in Nursing Science Programs, The Ohio State University College of Nursing, Columbus. Cindy Munro, PhD, ANP-BC, FAAN, FAANP, FAAAS, is Dean and Professor, University of Miami School of Nursing and Health Studies, Coral Gables. Cindy M. Anderson, PhD, APRN-CNP, ANEF, FAHA, FNAP, FAAN, is Senior Associate Dean for Academic Affairs and Educational Innovation and Professor, The Ohio State University College of Nursing, Columbus.
出版信息
Nurs Res. 2020 Nov/Dec;69(6):427-435. doi: 10.1097/NNR.0000000000000438.
BACKGROUND
Despite strong prevention efforts and advances in neonatal care in recent decades, low birth weight remains a serious public health problem in the United States, and survivors remain at increased risk for lifelong problems including cognitive deficits. Current regional and local strategies for referral often rely on variable thresholds for birth weight and gestational age that may be poor analogues to cognitive risk. Improving early referral criteria offers many benefits, including improved cognitive outcomes for children and improved cost-effectiveness and resource utilization in resource-limited communities.
OBJECTIVES
We hypothesized that social determinants measurable at birth or at birth hospital discharge, when combined with birth weight and gestational age, would offer an improvement over birth weight and gestational age alone in predicting cognitive test scores in school-aged children with low birth weight.
METHODS
We conducted a secondary analysis using a birth cohort of children from the Fragile Families and Child Wellbeing Study. We created a panel of maternal, familial, and community-level social determinant indicators from the data and examined associations with cognitive measures assessed at age of 9 years.
RESULTS
The final social determinant model was statistically significant and explained 35% of the total variance in composite test scores. The "standard care" model (birth weight and gestational age) only explained 9% of the variance.
DISCUSSION
Assessment of social determinants may offer improvement over traditional referral criteria to identify children most at risk of cognitive deficits after low birth weight.
背景
尽管近几十年来预防工作和新生儿护理取得了重大进展，但低出生体重在美国仍然是一个严重的公共卫生问题，幸存者仍然面临终生认知缺陷等风险增加的问题。目前，区域和当地的转介策略通常依赖于可变的出生体重和胎龄阈值，这些阈值可能与认知风险的模拟效果不佳。改进早期转介标准有很多好处，包括改善儿童的认知结果以及在资源有限的社区中提高成本效益和资源利用。
目的
我们假设，在出生时或出生医院出院时可测量的社会决定因素，与出生体重和胎龄相结合，在预测低出生体重学龄儿童的认知测试分数方面，将优于仅使用出生体重和胎龄。
方法
我们使用脆弱家庭和儿童健康研究的儿童出生队列进行了二次分析。我们从数据中创建了一个母体、家庭和社区层面社会决定因素指标的面板，并研究了这些指标与 9 岁时认知测量的关联。
结果
最终的社会决定因素模型具有统计学意义，解释了复合测试分数总方差的 35%。“标准护理”模型（出生体重和胎龄）仅解释了 9%的方差。
讨论
对社会决定因素的评估可能比传统的转介标准有所改进，可以识别出出生体重较低后最有可能出现认知缺陷的儿童。
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