Bolk Jenny, Källén Karin, Farooqi Aijaz, Hafström Maria, Fellman Vineta, Åden Ulrika, Serenius Fredrik
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Acta Paediatr. 2023 Apr;112(4):675-685. doi: 10.1111/apa.16651. Epub 2023 Jan 12.
Children born extremely preterm frequently have developmental coordination disorder (DCD). We aimed to evaluate perinatal risk factors for DCD.
Swedish national cohort study including 226 children born before 27 gestational weeks without major neurodevelopmental disabilities at 6.5 years. Outcome was DCD, defined as ≤5th percentile on the Movement Assessment Battery for Children-Second Edition. Perinatal risk factors were evaluated using multivariable logistic regression.
DCD was present in 84/226 (37.2%) children. Of the risk factors known at 40 weeks gestation, independent and significant risk factors for DCD were: mother's age at delivery (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.07-2.80); pre-eclampsia (2.79, 1.14-6.80); mother born in a non-Nordic country (2.23, 1.00-4.99); gestational age per week increase (0.70, 0.50-0.99) and retinopathy of prematurity (2.48, 1.26-4.87). Of factors known at discharge, postnatal steroids exposure (2.24, 1.13-4.46) and mechanical ventilation (1.76, 1.06-2.09) were independent risk factors when added to the model in separate analyses.
The risk of DCD in children born extremely preterm was multifactorial and associated with gestational age largely mediated by ROP, maternal factors, pre-eclampsia, administration of postnatal steroids and mechanical ventilation. These risk factors are common among children born extremely preterm, contributing to their high risk of DCD.
极早产儿出生后常患发育性协调障碍（DCD）。我们旨在评估DCD的围产期危险因素。
瑞典全国队列研究，纳入226名孕27周前出生且6.5岁时无重大神经发育障碍的儿童。结局指标为DCD，定义为儿童运动评估量表第二版得分≤第5百分位数。采用多变量逻辑回归评估围产期危险因素。
226名儿童中有84名（37.2%）患DCD。在孕40周时已知的危险因素中，DCD的独立且显著的危险因素为：母亲分娩年龄（比值比[OR]1.73，95%置信区间[CI]1.07 - 2.80）；子痫前期（2.79，1.14 - 6.80）；母亲出生于非北欧国家（2.23，1.00 - 4.99）；孕周每周增加（0.70，0.50 - 0.99）以及早产儿视网膜病变（2.48，1.26 - 4.87）。在出院时已知的因素中，单独分析时，产后类固醇暴露（2.24，1.13 - 4.46）和机械通气（1.76，1.06 - 2.09）加入模型后为独立危险因素。
极早产儿患DCD的风险是多因素的，且与孕周相关，主要由早产儿视网膜病变、母亲因素、子痫前期、产后类固醇的使用及机械通气介导。这些危险因素在极早产儿中很常见，导致他们患DCD的风险很高。
