Jansen Lisette, Peeters-Scholte Cacha M P C D, van den Berg-Huysmans Annette A, van Klink Jeanine M M, Rijken Monique, van Egmond-van Dam Janneke C, Vermeiren Robert R J M, Steggerda Sylke J
Department of Medical Psychology, Leiden University Medical Center, Leiden, Netherlands.
Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Curium, Leiden, Netherlands.
Front Pediatr. 2021 Jun 21;9:674221. doi: 10.3389/fped.2021.674221. eCollection 2021.
To investigate the rate and stability of impairments in children born preterm by assessing (1) early and school-age outcome in four developmental domains and (2) individual changes in outcome at both timepoints. Prospective, longitudinal cohort study in children born in 2006-2007, <32 weeks' gestation. Follow-up at 2 and 10 years of age included standardized neurological, motor, cognitive and behavioral assessments. Children were categorized as having no, mild or moderate-severe impairment in these four domains. A composite impairment score was composed and the number of domains with impairments counted. For each child, individual outcomes at both timepoints were compared. Follow-up at both time-points was available in 71/113(63%) children. At group level, there were no significant changes in the severity of impairments per domain. However, at individual level, there were less children with a mild abnormal composite score at 10 years of age (44 vs. 20%; = 0.006), and more with a moderate-severe abnormal composite score (12 vs. 35%; p = 0.001). Especially children with normal/mild outcome at 2 years were likely to shift to other outcome categories over time. Children with early severe impairment are likely experiencing impairments later on, but early normal/mild abnormal outcomes should be interpreted with care, considering the large individual shifts over time. Long-term follow-up in all children born very preterm should therefore be continued to at least school-age.
通过评估（1）四个发育领域的早期和学龄期结局，以及（2）两个时间点结局的个体变化，来调查早产儿童损伤的发生率和稳定性。对2006 - 2007年出生、孕周<32周的儿童进行前瞻性纵向队列研究。在2岁和10岁时进行随访，包括标准化的神经、运动、认知和行为评估。将儿童在这四个领域分为无损伤、轻度损伤或中度 - 重度损伤。组成一个综合损伤评分，并计算有损伤的领域数量。比较每个儿童在两个时间点的个体结局。113名儿童中有71名（63%）在两个时间点均有随访。在组水平上，每个领域损伤的严重程度没有显著变化。然而，在个体水平上，10岁时综合评分轻度异常的儿童较少（44%对20%；P =0.006），中度 - 重度异常综合评分的儿童较多（12%对35%；P =0.001）。特别是2岁时结局正常/轻度异常的儿童随着时间推移可能会转变为其他结局类别。早期有严重损伤的儿童后期可能仍有损伤，但考虑到个体随时间的巨大变化，早期正常/轻度异常结局应谨慎解读。因此，所有极早产儿童都应继续进行至少到学龄期的长期随访。
