Beatrix Children's Hospital, Division of Neonatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Early Hum Dev. 2021 May;156:105350. doi: 10.1016/j.earlhumdev.2021.105350. Epub 2021 Mar 17.
Accurate prediction of persistent and emerging developmental problems in preterm-born children may lead to targeted interventions.
To determine whether specific perinatal and social factors were associated with persistent, emerging, and resolving developmental problems of early-preterm (EPs) and moderately-and-late-preterm children (MLPs) from before to after school entry.
Observational longitudinal cohort study, part of the LOLLIPOP cohort-study.
341 EPs and 565 MLPs.
Developmental problems using the Ages and Stages Questionnaire at ages 4 and 5. We collected data on perinatal and social factors from medical records. Using logistic regression analyses we assessed associations between 48 factors and persistent, emerging, and resolving problems.
Of EPs, 8.7% had persistent and 5.1% emerging problems; this was 4.3% and 1.9% for MLPs, respectively. Predictors for persistent problems included chronic mental illness of the mother, odds ratio (95% confidence interval) 8.01 (1.85-34.60), male sex 4.96 (2.28-10.82), being born small-for-gestational age (SGA) 2.39 (1.15-4.99), and multiparity 3.56 (1.87-6.76). Predictors for emerging problems included MLP birth with prolonged premature rupture of membranes (PPROM) 5.01 (1.38-18.14). Including all predictors in a single prediction model, the explained variance (Nagelkerke R) was 21.9%, whereas this was 3.0% with only EP/MLP birth as predictor.
Only few perinatal and social factors had associations with persistent and emerging developmental problems for both EPs and MLPs. For children with specific neonatal conditions such as SGA, and PPROM in MLPs, problems may persist. Insight in risk factors largely improved the prediction of developmental problems among preterm children.
准确预测早产儿持续和新出现的发育问题可能会导致有针对性的干预。
确定特定的围产期和社会因素是否与早产（EP）和中晚期早产儿（MLP）从入学前到入学后的持续、新出现和解决的发育问题相关。
观察性纵向队列研究，LOLLIPOP 队列研究的一部分。
341 名 EP 和 565 名 MLP。
使用年龄和阶段问卷在 4 岁和 5 岁时评估发育问题。我们从病历中收集围产期和社会因素的数据。使用逻辑回归分析评估 48 个因素与持续、新出现和解决问题之间的关联。
EP 中，8.7%有持续问题，5.1%有新出现问题；MLP 中，分别为 4.3%和 1.9%。持续问题的预测因素包括母亲的慢性精神疾病，优势比（95%置信区间）8.01（1.85-34.60），男性 4.96（2.28-10.82），出生时小于胎龄（SGA）2.39（1.15-4.99），和多胎妊娠 3.56（1.87-6.76）。新出现问题的预测因素包括 MLP 出生时伴有延长的胎膜早破（PPROM）5.01（1.38-18.14）。在单个预测模型中包含所有预测因素，解释方差（Nagelkerke R）为 21.9%，而仅使用 EP/MLP 出生作为预测因素时为 3.0%。
只有少数围产期和社会因素与 EP 和 MLP 的持续和新出现的发育问题相关。对于 SGA 等特定新生儿情况的儿童和 MLP 中的 PPROM，问题可能会持续存在。对风险因素的深入了解大大提高了对早产儿发育问题的预测能力。
