Whitaker A H, Van Rossem R, Feldman J F, Schonfeld I S, Pinto-Martin J A, Tore C, Shaffer D, Paneth N
Division of Child and Adolescent Psychiatry, Columbia University, New York, NY, USA.
Arch Gen Psychiatry. 1997 Sep;54(9):847-56. doi: 10.1001/archpsyc.1997.01830210091012.
This study examined the relation of neonatal cranial ultrasound abnormalities to psychiatric disorder at age 6 years in a regional birth cohort of low-birth-weight children.
Neonatal cranial ultrasound abnormalities were classified as (1) isolated germinal matrix and/or intraventricular hemorrhage (suggestive of injury to glial precursors) or (2) parenchymal lesions and/or ventricular enlargement (suggestive of white matter injury) with or without germinal matrix-intraventricular hemorrhage. Psychiatric disorders by DSM-III-R at age 6 years were assessed by means of a structured parent interview. Children with severe mental retardation were excluded. Analyses were conducted first in the entire sample and then in children with normal intelligence.
Twenty-two percent of the cohort had at least 1 psychiatric disorder, the most common being attention deficit hyperactivity disorder (15.6%). In the entire sample, parenchymal lesions and/or ventricular enlargement increased risk relative to no abnormality, independently of other biological and social predictors, for any disorder (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.8-10.3; P < .001), attention deficit hyperactivity disorder (OR, 3.4; CI, 1.3-8.7; P = .02), and tic disorders (OR, 8.7; CI, 1.3-57.7; P = .02). In children of normal intelligence, parenchymal lesions/ventricular enlargement independently increased risk for any disorder (OR, 4.8; CI, 1.6-12.0; P < .01), attention deficit hyperactivity disorder (OR, 4.5; CI, 1.3-16.0; P = .02), and separation anxiety (OR, 5.3; CI, 1.1-24.8; P = .03). These effects were not ameliorated by female sex or social advantage. Isolated germinal matrix/intraventricular hemorrhage was not related to psychiatric disorder at age 6 years.
Neonatal cranial ultrasound abnormalities suggestive of white matter injury significantly increased risk for some psychiatric disorders at age 6 years in low-birth-weight children.
本研究在一个低体重儿童区域出生队列中，考察了新生儿颅脑超声异常与6岁时精神障碍之间的关系。
新生儿颅脑超声异常被分类为：（1）孤立性生发基质和/或脑室内出血（提示神经胶质前体细胞损伤），或（2）实质病变和/或脑室扩大（提示白质损伤），伴有或不伴有生发基质-脑室内出血。通过结构化家长访谈评估6岁时符合《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）的精神障碍。排除重度智力发育迟缓儿童。首先在整个样本中进行分析，然后在智力正常的儿童中进行分析。
该队列中22%的儿童至少患有一种精神障碍，最常见的是注意力缺陷多动障碍（15.6%）。在整个样本中，与无异常相比，实质病变和/或脑室扩大增加了患任何障碍（优势比[OR]，4.4；95%置信区间[CI]，1.8 - 10.3；P <.001）、注意力缺陷多动障碍（OR，3.4；CI，1.3 - 8.7；P =.02）和抽动障碍（OR，8.7；CI，1.3 - 57.7；P =.02）的风险，且独立于其他生物学和社会预测因素。在智力正常的儿童中，实质病变/脑室扩大独立增加了患任何障碍（OR，4.8；CI，1.6 - 12.0；P <.01）、注意力缺陷多动障碍（OR，4.5；CI，1.3 - 16.0；P =.02）和分离焦虑（OR，5.3；CI，1.1 - 24.8；P =.03）的风险。这些影响不会因女性性别或社会优势而减轻。孤立性生发基质/脑室内出血与6岁时的精神障碍无关。
提示白质损伤的新生儿颅脑超声异常显著增加了低体重儿童6岁时患某些精神障碍的风险。
