Agyeman-Duah Josephine, Kennedy Stephen, O'Brien Frances, Natalucci Giancarlo
Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
Newborn Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Gates Open Res. 2021 Sep 21;5:78. doi: 10.12688/gatesopenres.13246.2. eCollection 2021.
Prematurity (birth before 37 weeks' gestation) is associated with wide-ranging neurodevelopmental impairment. Prognosis among moderate to late (32 to <37 weeks' gestation) preterm infants (MLPT) is better compared to their counterparts born very preterm (<32 weeks' gestation). However the risk of developmental impairment among MLPT, who make up about 84% of all preterm infants, is 2-3 times higher when compared to infants born at term. Early interventions have aimed to improve outcomes in preterm infants generally, but there are limited data on their need and effect in MLPT specifically. Prioritising research, long-term follow-up and early interventions targeted at ameliorating the impact of preterm birth among MLPT is required. To conduct a systematic review of the type of early childhood interventions (from birth until 4 years of age) offered to MLPT children and to evaluate their impact on neurodevelopmental outcomes (cognitive, neurobehavioural and motor) as assessed in these children during childhood (until 18 years of age). A systematic literature search in Web of Science, Medline Ovid, PsycINFO, CINAHL and EMBASE will be conducted. Data on MLPT children receiving developmental interventions until the age of 4 years will be evaluated. Interventions may involve parents or primary caregivers. Primary outcomes are cognitive, neurobehavioural and motor development as measured from birth until the age of 18 years. The Cochrane Risk of Bias Assessment Tool will be used to evaluate the methodological quality of randomised controlled trials (RCTs) included in the review and will be graded as low, high or unclear risk of bias. The quality of non-RCTs will be evaluated with the Newcastle-Ottawa Scale. The quality of evidence for each outcome will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation Approach. Publication and reporting bias will be assessed using Egger's test and funnel plots respectively.
早产（妊娠37周前出生）与广泛的神经发育障碍有关。中度至晚期（妊娠32至<37周）早产儿（MLPT）的预后比极早产儿（<32周妊娠）更好。然而，占所有早产儿约84%的MLPT发生发育障碍的风险是足月儿的2至3倍。早期干预总体上旨在改善早产儿的结局，但关于其在MLPT中的必要性和效果的数据有限。需要优先开展针对减轻MLPT早产影响的研究、长期随访和早期干预。对提供给MLPT儿童的幼儿期干预类型（从出生到4岁）进行系统评价，并评估其对这些儿童在儿童期（直至18岁）所评估的神经发育结局（认知、神经行为和运动）的影响。将在科学网、Ovid医学数据库、心理学文摘数据库、护理学与健康领域数据库和EMBASE中进行系统的文献检索。将评估接受发育干预至4岁的MLPT儿童的数据。干预可能涉及父母或主要照顾者。主要结局是从出生到18岁测量的认知、神经行为和运动发育。将使用Cochrane偏倚风险评估工具来评估纳入评价的随机对照试验（RCT）的方法学质量，并将其分级为低、高或偏倚风险不明确。非RCT的质量将使用纽卡斯尔-渥太华量表进行评估。将使用推荐分级评估、制定和评价方法对每个结局的证据质量进行评估。分别使用Egger检验和漏斗图评估发表偏倚和报告偏倚。
