Halsey C L, Collin M F, Anderson C L
Dept of Pediatrics, Loyola University Medical Center, Maywood, IL 60153.
Pediatrics. 1993 Apr;91(4):807-11.
Though not well studied, extremely low birth weight (ELBW; < 1000 g) appears to be a major risk factor for developmental disability, with most affected children experiencing school problems (40% to 64%) rather than severe handicap (25%). This study marks the first published US attempt to document prospectively the developmental/educational progress of a cohort of predominantly white, middle-class ELBW children with randomly selected and matched heavier birth weight (1500 through 2500 g and > 2500 g) peer comparison groups. Sixty ELBW children and 60 peers were administered a test battery at age 4 years, including the McCarthy Scales of Children's Abilities, Peabody Picture Vocabulary Test, and Beery Test of Visual-Motor Integration. The ELBW group mean scores were significantly lower than those of the peer groups on every measure, although generally still within 1 SD of the test mean. Twenty-three percent were clearly disabled; 26% had optimal development, having attained at least average scores on all measures; and 51% attained borderline scores globally or had an average cognitive score, but specifically poor performance in one or more areas. Comparison groups were 2 1/2 times more likely to have optimal development and had mean cognitive scores 15 to 18 points higher than the ELBW group. In summary, weaker performance on all measures exists prior to school entry among nondisabled ELBW children compared with their peers. It is unclear whether these data portend emerging school-based disabilities or describe a continuing recovery process to be completed in middle childhood. Continued follow-up of this cohort at 7 and 10 years of age will address these questions.
尽管研究尚不充分，但极低出生体重（ELBW；<1000克）似乎是发育障碍的主要风险因素，大多数受影响儿童存在学业问题（40%至64%），而非严重残疾（25%）。本研究是美国首次发表的前瞻性记录一组主要为白人、中产阶级的极低出生体重儿童发育/教育进展的尝试，并设有随机选择且匹配的出生体重较重（1500至2500克及>2500克）的同龄对照组。对60名极低出生体重儿童和60名同龄人在4岁时进行了一系列测试，包括麦卡锡儿童能力量表、皮博迪图片词汇测试和贝里视觉运动整合测试。极低出生体重组在各项测试中的平均得分均显著低于对照组，不过总体上仍在测试平均分的1个标准差范围内。23%的儿童明显存在残疾；26%发育良好，在所有测试中至少达到平均分；51%的儿童总体得分处于临界水平或认知平均得分，但在一个或多个领域表现特别差。对照组发育良好的可能性是极低出生体重组的2.5倍，平均认知得分比极低出生体重组高15至18分。总之，与同龄人相比，未残疾的极低出生体重儿童在入学前各项测试中的表现较弱。目前尚不清楚这些数据预示着是否会出现基于学校的残疾，还是描述了一个在童年中期完成的持续恢复过程。对该队列在7岁和10岁时的持续随访将解答这些问题。
