Christensen Rhandi, Chau Vann, Synnes Anne, Guo Ting, Grunau Ruth E, Miller Steven P
Division of Neurology, Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada.
J Pediatr. 2023 Jul;258:113401. doi: 10.1016/j.jpeds.2023.113401. Epub 2023 Apr 3.
To assess the longitudinal trajectory of cognitive, language, and motor outcomes from 18 months to 4.5 years of age in children born very preterm.
This was a prospective cohort study of 163 infants born very preterm (born 24-32 weeks of gestation) followed longitudinally and assessed with neurodevelopmental scales and magnetic resonance imaging of the brain. Outcomes at 18 months and 3 years were assessed with the Bayley Scales of Infant and Toddler Development, 3rd Edition, and at 4.5 years with the Wechsler Preschool and Primary Scale of Intelligence-III and the Movement Assessment Battery for Children. Cognitive, language, and motor outcomes were categorized as below-average, average, and above-average, and compared across time. Clinical data were analyzed using ANOVA, χ tests, and linear regression.
Cognitive and language trajectories were stable from 18 months to 4.5 years for all outcome groups. Motor impairment increased over time, with a greater proportion of children having motor deficits at 4.5 years. Children with below-average cognitive and language outcomes at 4.5 years had more clinical risk factors, greater white matter injury, and lower maternal education. Children with severe motor impairment at 4.5 years were born earlier, had more clinical risk factors, and demonstrated greater white matter injury.
Children born preterm have stable cognitive and language trajectories, while motor impairment increased at 4.5 years. These results highlight the importance of continued developmental surveillance for children born preterm into preschool age.
评估极早产儿从18个月至4.5岁时认知、语言和运动能力的纵向发展轨迹。
这是一项对163名极早产儿（孕24 - 32周出生）进行的前瞻性队列研究，对其进行纵向跟踪，并使用神经发育量表和脑部磁共振成像进行评估。18个月和3岁时的结果采用贝利婴幼儿发展量表第3版进行评估，4.5岁时采用韦氏学前及初小儿童智力测验第三版和儿童运动评估量表进行评估。认知、语言和运动能力结果分为低于平均水平、平均水平和高于平均水平，并在不同时间进行比较。临床数据采用方差分析、χ检验和线性回归进行分析。
所有结果组的认知和语言发展轨迹在18个月至4.5岁期间保持稳定。运动障碍随时间增加，4.5岁时运动功能缺陷的儿童比例更高。4.5岁时认知和语言能力低于平均水平的儿童有更多临床风险因素、更严重的白质损伤且母亲受教育程度较低。4.5岁时严重运动障碍的儿童出生更早，有更多临床风险因素，且白质损伤更严重。
早产儿的认知和语言发展轨迹稳定，而运动障碍在4.5岁时增加。这些结果凸显了对早产儿直至学龄前持续进行发育监测的重要性。
