Whitfield M F, Grunau R V, Holsti L
Department of Paediatrics, University of British Columbia, Vancouver, Canada.
Arch Dis Child Fetal Neonatal Ed. 1997 Sep;77(2):F85-90. doi: 10.1136/fn.77.2.f85.
To examine the functional abilities of extremely low birthweight (ELBW, < or = 800 g) children at school age compared with full term children.
ELBW children (n = 115) in a geographically defined regional cohort born between 1974 and mid-1985 (comprising 96% of 120 survivors of 400 ELBW infants admitted to the Provincial Tertiary neonatal intensive care unit), were compared with (n = 50) children of comparable age and sociodemographic status. Each child was categorised by the pattern and degree of disability, using a system derived from the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM IV). Psycho-educational, behavioural, and motor results for ELBW children free of severe/multiple neurosensory disabilities (n = 90; 91% return rate) were compared with the term children.
Severe/multiple neurosensory disabilities were present in 16 ELBW children (14%), and 15 (13%) had borderline intelligence. ELBW children of global IQ > or = 85 scored significantly lower in standardised tests of fine and gross motor control, visuo-motor pencil output, visual memory, and academic achievement (reading, arithmetic, written language). ELBW survivors were three times more likely to have learning disorders (47% vs 18%) and 22 (41%) of the 54 ELBW children with learning disorders had multiple areas of learning difficulty. Of the ELBW group, 30 (26%) were not disabled compared with 41 (82%) of the term group. Only five (12%) of the ELBW boys were not disabled, compared with 25 (35%) of the ELBW girls. Finally, ELBW children had significantly worse scores on ratings of behaviour during testing by the psychologist and behaviour by parental report.
The most likely outcome for ELBW survivors at school age is a learning disorder, often multiple, or borderline intellectual functioning, combined with behavioural and motor risk factors rather than severe/multiple disability. Mean scores on psycho-educational testing showed poorer performance of the ELBW children, but grossly understated the complex nature of the individual degree of educational difficulty faced by these children.
对比极低出生体重（ELBW，≤800克）儿童与足月儿在学龄期的功能能力。
将1974年至1985年年中在一个地理区域队列中出生的ELBW儿童（n = 115）（包括省级三级新生儿重症监护病房收治的400名ELBW婴儿中的120名幸存者中的96%）与年龄和社会人口统计学状况相当的（n = 50）儿童进行比较。使用源自美国精神病学协会《诊断与统计手册》（DSM-IV）的系统，根据残疾模式和程度对每个儿童进行分类。将无严重/多重神经感觉障碍的ELBW儿童（n = 90；回访率91%）的心理教育、行为和运动结果与足月儿进行比较。
16名ELBW儿童（14%）存在严重/多重神经感觉障碍，15名（13%）智力处于临界水平。全球智商≥85的ELBW儿童在精细和粗大运动控制、视动铅笔书写、视觉记忆及学业成绩（阅读、算术、书面语言）的标准化测试中得分显著较低。ELBW幸存者患学习障碍的可能性是足月儿的三倍（47%对18%），54名有学习障碍的ELBW儿童中有22名（41%）存在多个学习困难领域。ELBW组中30名（26%）无残疾，而足月儿组为41名（82%）。ELBW男孩中只有5名（12%）无残疾，而ELBW女孩中有25名（35%）。最后，在心理学家测试期间的行为评分以及家长报告的行为方面，ELBW儿童得分显著更低。
ELBW幸存者在学龄期最可能的结果是学习障碍，通常是多重的，或智力功能处于临界水平，同时伴有行为和运动风险因素，而非严重/多重残疾。心理教育测试的平均得分显示ELBW儿童表现较差，但严重低估了这些儿童个体所面临的教育困难的复杂性质。
