Lucas A, Morley R, Cole T J
Medical Research Council Childhood Nutrition Research Centre, Institute of Child Health, London WC1N 1EH, UK.
BMJ. 1998 Nov 28;317(7171):1481-7. doi: 10.1136/bmj.317.7171.1481.
To determine whether perinatal nutrition influences cognitive function at 7 1/2 - 8 years in children born preterm.
Randomised, blinded nutritional intervention trial. Blinded follow up at 7 1/2 - 8 years.
Intervention phase in two neonatal units; follow up in a clinic or school setting.
424 preterm infants who weighed under 1850 g at birth; 360 of those who survived were tested at 7 1/2 - 8 years.
Standard infant formula versus nutrient enriched preterm formula randomly assigned as sole diet (trial A) or supplements to maternal milk (trial B) fed for a mean of 1 month.
Intelligence quotient (IQ) at 7 1/2 - 8 years with abbreviated Weschler intelligence scale for children (revised).
There was a major sex difference in the impact of diet. At 7 1/2 - 8 years boys previously fed standard versus preterm formula as sole diet had a 12.2 point disadvantage (95% confidence interval 3.7 to 20.6; P<0.01) in verbal IQ. In those with highest intakes of trial diets corresponding figures were 9.5 point disadvantage and 14.4 point disadvantage in overall IQ (1.2 to 17.7; P<0.05) and verbal IQ (5.7 to 23.2; P<0.01). Consequently, more infants fed term formula had low verbal IQ (<85): 31% versus 14% for both sexes (P=0.02) and 47% versus 13% in boys P=0.009). There was a higher incidence of cerebral palsy in those fed term formula; exclusion of such children did not alter the findings.
Preterm infants are vulnerable to suboptimal early nutrition in terms of their cognitive performance--notably, language based skills--at 7 1/2 - 8 years, when cognitive scores are highly predictive of adult ones. Our data on cerebral palsy generate a new hypothesis that suboptimal nutritional management during a critical or plastic early period of rapid brain growth could impair functional compensation in those sustaining an earlier brain insult. Cognitive function, notably in males, may be permanently impaired by suboptimal neonatal nutrition.
确定围产期营养是否会影响早产出生儿童在7岁半至8岁时的认知功能。
随机、盲法营养干预试验。在7岁半至8岁时进行盲法随访。
在两个新生儿病房进行干预阶段；在诊所或学校环境中进行随访。
424名出生时体重低于1850克的早产儿；其中360名存活者在7岁半至8岁时接受了测试。
标准婴儿配方奶粉与营养强化早产儿配方奶粉，随机分配作为唯一饮食（试验A）或作为母乳补充剂（试验B），平均喂养1个月。
使用儿童韦氏智力量表简式量表（修订版）测量在7岁半至8岁时的智商（IQ）。
饮食的影响存在显著的性别差异。在7岁半至8岁时，此前以标准配方奶粉与早产儿配方奶粉作为唯一饮食的男孩，其言语智商有12.2分的劣势（95%置信区间为3.7至20.6；P<0.01）。在试验饮食摄入量最高的人群中，相应的总体智商劣势为9.5分，言语智商劣势为14.4分（总体智商1.2至17.7；P<0.05；言语智商5.7至23.2；P<0.01）。因此，更多食用足月儿配方奶粉的婴儿言语智商较低（<85）：男女合计分别为31%和14%（P=0.02），男孩分别为47%和13%（P=0.009）。食用足月儿配方奶粉的儿童脑瘫发病率更高；排除这些儿童后结果未改变。
早产儿在7岁半至8岁时，就其认知表现而言，尤其是基于语言的技能，易受早期营养欠佳的影响，此时的认知分数对成人认知分数具有高度预测性。我们关于脑瘫的数据提出了一个新的假说，即在脑快速生长的关键或可塑性早期阶段，营养管理欠佳可能会损害那些早期遭受脑损伤者的功能代偿。认知功能，尤其是男性的认知功能，可能会因新生儿营养欠佳而受到永久性损害。
