出生体重低于750克儿童的学龄期结局

School-age outcomes in children with birth weights under 750 g.

作者信息

Hack M, Taylor H G, Klein N, Eiben R, Schatschneider C, Mercuri-Minich N

机构信息

Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OH.

出版信息

N Engl J Med. 1994 Sep 22;331(12):753-9. doi: 10.1056/NEJM199409223311201.

DOI:10.1056/NEJM199409223311201

PMID:7520533

Abstract

BACKGROUND

Since the mid-1980s, increasing numbers of children with birth weights under 750 g have survived to school age.

METHODS

We matched a regional cohort of 68 surviving children born from 1982 through 1986 with birth weights under 750 g (mean, 670 g; gestational age, 25.7 weeks) with 65 children weighting 750 to 1499 g at birth and 61 children born at term. Growth, neurosensory status, and functioning at school age in the three groups were compared. Associations of biologic and social risk factors with major developmental outcomes were examined by means of logistic-regression analyses.

RESULTS

Children with birth weights under 750 g were inferior to both comparison groups in cognitive ability, psychomotor skills, and academic achievement. They had poorer social skills and adaptive behavior and more behavioral and attention problems. The mean (+/- SD) Mental Processing Composite score for the cohort was 87 +/- 15, as compared with 93 +/- 14 for children with birth weights of 750 to 1499 g and 100 +/- 13 for children born at term (P < 0.001). The rates of mental retardation (IQ < 70) in the three groups were 21, 8, and 2 percent, respectively; the rates of cerebral palsy were 9, 6, and 0 percent; and the rates of severe visual disability were 25, 5, and 2 percent. Major cerebral ultrasonographic abnormalities were associated with mental retardation (odds ratio, 5.4; 95 percent confidence interval, 1.8 to 15.8) and cerebral palsy (odds ratio, 15.2; 95 percent confidence interval, 3.0 to 77.4). Oxygen dependence at 36 weeks was associated with mental retardation (odds ratio, 4.5; 95 percent confidence interval, 1.2 to 10.7) and severe visual disability (odds ratio, 4.3; 95 percent confidence interval, 1.3 to 14.2). Social disadvantage, though associated with several neuropsychological outcomes, was not associated with major developmental impairment.

CONCLUSIONS

Children with birth weights under 750 g who survive represent a subgroup of very-low-birth-weight children who are at high risk for neurobehavioral dysfunction and poor school performance.

摘要

背景

自20世纪80年代中期以来，越来越多出生体重低于750克的儿童存活至学龄期。

方法

我们将1982年至1986年出生、出生体重低于750克（平均670克；胎龄25.7周）的68名存活儿童组成的区域队列，与65名出生体重在750至1499克之间的儿童以及61名足月出生的儿童进行匹配。比较了三组儿童在学龄期的生长、神经感觉状态和功能情况。通过逻辑回归分析研究了生物学和社会风险因素与主要发育结局之间的关联。

结果

出生体重低于750克的儿童在认知能力、心理运动技能和学业成绩方面均不如两个对照组。他们的社交技能和适应性行为较差，行为和注意力问题更多。该队列儿童的平均（±标准差）心理加工综合得分是87±15，出生体重在750至1499克之间的儿童为93±14，足月出生的儿童为100±13（P<0.001）。三组儿童的智力迟钝（智商<70）发生率分别为21%、8%和2%；脑瘫发生率分别为9%、6%和0%；严重视力残疾发生率分别为25%、5%和2%。主要的脑超声异常与智力迟钝（优势比，5.4；95%置信区间，1.8至15.8）和脑瘫（优势比，15.2；95%置信区间为3.0至77.4）相关。36周时的氧依赖与智力迟钝（优势比，4.5；95%置信区间，1.2至10.7）和严重视力残疾（优势比，4.3；95%置信区间为1.3至14.2）相关。社会劣势虽然与一些神经心理学结局相关，但与主要发育障碍无关。