Crockett L K, Ruth C A, Heaman M I, Brownell M D
Department of Community Health Sciences, Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 374(1) - 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.
Manitoba Centre for Health Policy, University of Manitoba, 408 - 727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
Matern Child Health J. 2022 May;26(5):1126-1141. doi: 10.1007/s10995-022-03403-8. Epub 2022 Mar 17.
Early life exposures can have an impact on a child's developmental trajectory and children born late preterm (34-36 weeks gestational age) are increasingly recognized to have health and developmental setbacks that extend into childhood.
The purpose of this study was to assess whether late preterm birth was associated with poorer developmental and educational outcomes in the early childhood period, after controlling for health and social factors.
We conducted a retrospective cohort study using administrative databases housed at the Manitoba Centre for Health Policy, including all children born late preterm (34-36 weeks gestational age (GA)) and at full-term (39-41 weeks GA) between 2000 and 2005 in urban Manitoba (N = 28,100). Logistic regression was used to examine the association between gestational age (GA) and outcomes, after adjusting for covariates.
Adjusted analyses demonstrated that children born late preterm had a higher prevalence of attention deficit hyperactivity disorder (ADHD) (aOR = 1.25, 95% CI [1.03, 1.51]), were more likely to be vulnerable in the language and cognitive (aOR = 1.29, 95% CI [1.06, 1.57]), communication and general knowledge (aOR = 1.24, 95% CI [1.01, 1.53]), and physical health and well-being (aOR = 1.27, 95% CI [1.04, 1.53]) domains of development at kindergarten, and were more likely to repeat kindergarten or grade 1 (aOR = 1.52, 95% CI [1.03, 2.25]) compared to children born at term. They did not differ in receipt of special education funding, in social maturity or emotional development at kindergarten, and in reading and numeracy assessments in the third grade.
Given that the late preterm population makes up 75% of the preterm population, their poorer outcomes have implications at the population level. This study underscores the importance of recognizing the developmental vulnerability of this population and adequately accounting for the social differences between children born late preterm and at term.
早期生活暴露会对儿童的发育轨迹产生影响，越来越多的人认识到晚期早产儿（孕龄34 - 36周）会出现持续至童年期的健康和发育挫折。
本研究的目的是在控制健康和社会因素后，评估晚期早产是否与幼儿期较差的发育和教育结果相关。
我们使用曼尼托巴省卫生政策中心的行政数据库进行了一项回顾性队列研究，研究对象包括2000年至2005年在曼尼托巴省城市出生的所有晚期早产儿（孕龄34 - 36周）和足月儿（孕龄39 - 41周）（N = 28,100）。在调整协变量后，使用逻辑回归分析来检验孕龄与结果之间的关联。
校正分析表明，与足月儿相比，晚期早产儿患注意力缺陷多动障碍（ADHD）的患病率更高（调整后比值比[aOR]=1.25，95%置信区间[CI][1.03, 1.51]），在幼儿园阶段，在语言和认知（aOR = 1.29，95% CI [1.06, 1.57]）、沟通和常识（aOR = 1.24，95% CI [1.01, 1.53]）以及身体健康和幸福感（aOR = 1.27，95% CI [1.04, 1.53]）等发育领域更易出现问题，并且更有可能重读幼儿园或一年级（aOR = 1.52，95% CI [1.03, 2.25]）。他们在接受特殊教育资金、幼儿园阶段的社会成熟度或情感发展以及三年级的阅读和算术评估方面没有差异。
鉴于晚期早产儿占早产人群的75%，他们较差的结果在人群层面具有重要意义。本研究强调了认识这一人群发育脆弱性以及充分考虑晚期早产儿和足月儿之间社会差异的重要性。
