法国巴黎大学Véronique Pierrat团队研究了早产儿5岁时的神经发育结局。2021年4月28日，《英国医学杂志》发表了该成果。
为了描述早产儿5岁时的神经发育，2011年，研究组在法国进行了一项基于人群的队列研究，共招募了4441名于24-26周、27-31周和32-34周出生的5岁半儿童。重度/中度神经发育障碍，定义为重度/中度脑性瘫痪（大运动功能分类系统GMFCS≥2）、或单侧或双侧失明或耳聋、或全量表智商小于负两个标准差（韦氏学龄前和初级智力量表，第4版）。
轻度神经发育障碍，定义为轻度脑性瘫痪（GMFCS-1）、或视力障碍≥3.2/10和<5/10、或听力损失<40分贝、或全量表智商（负2到负1个标准差）、或发育协调障碍（儿童运动评估组合，第2版，总分小于或等于第5个百分位数）、或行为困难（力量和困难问卷，总分大于或等于90分）、接受学校援助（有支持的主流班级或特殊学校）、复杂的发展干预以及家长对发展的关注。以当代足月儿的得分分布为参考。
在4441名受试者中，共有3083名（69.4%）儿童接受了评估。24-26周、27-31周和32-34周出生的早产儿童中，重度/中度神经发育障碍的发生率分别为28%、19%和12%，轻度残疾的发生率分别为38.5%、36%和34%。24-26周、27-31周和32-34周出生的早产儿童中，分别有27%、14%和7%的儿童接受了学校援助。在24-26周出生的早产儿童中有52%至少接受过一次发育干预，而在32-34周出生的早产儿童中，这一比例降至26%。行为是父母最常报告的问题。神经发育障碍的发生率随着胎龄的降低而增加，在社会经济地位较低的家庭中则更高。
研究结果表明，在这一庞大的早产儿童队列中，每个胎龄组的重度/中度神经发育障碍发生率仍然很高。接受学校援助或复杂发展干预的儿童比例可能会对教育和卫生组织产生重大影响。父母对早产儿行为的担忧亦值得关注。
附：英文原文
Title: Neurodevelopmental outcomes at age 5 among children born preterm: EPIPAGE-2 cohort study
Author: Véronique Pierrat, Laetitia Marchand-Martin, Stéphane Marret, Catherine Arnaud, Valérie Benhammou, Gilles Cambonie, Thierry Debillon, Marie-Nolle Dufourg, Catherine Gire, Franois Goffinet, Monique Kaminski, Alexandre Lapillonne, Andrei Scott Morgan, Jean-Christophe Rozé, Sabrina Twilhaar, Marie-Aline Charles, Pierre-Yves Ancel
Issue&Volume: 2021/04/28
Abstract:
Objectives To describe neurodevelopment at age 5 among children born preterm.
Design Population based cohort study, EPIPAGE-2.
Setting France, 2011.
Participants 4441 children aged 5 born at 24-26, 27-31, and 32-34 weeks
Main outcome measures Severe/moderate neurodevelopmental disabilities, defined as severe/moderate cerebral palsy (Gross Motor Function Classification System (GMFCS) ≥2), or unilateral or bilateral blindness or deafness, or full scale intelligence quotient less than minus two standard deviations (Wechsler Preschool and Primary Scale of Intelligence, 4th edition). Mild neurodevelopmental disabilities, defined as mild cerebral palsy (GMFCS-1), or visual disability ≥3.2/10 and <5/10, or hearing loss <40 dB, or full scale intelligence quotient (minus two to minus one standard deviation) or developmental coordination disorders (Movement Assessment Battery for Children, 2nd edition, total score less than or equal to the fifth centile), or behavioural difficulties (strengths and difficulties questionnaire, total score greater than or equal to the 90th centile), school assistance (mainstream class with support or special school), complex developmental interventions, and parents’ concerns about development. The distributions of the scores in contemporary term born children were used as reference. Results are given after multiple imputation as percentages of outcome measures with exact binomial 95% confidence intervals.
Results Among 4441 participants, 3083 (69.4%) children were assessed. Rates of severe/moderate neurodevelopmental disabilities were 28% (95% confidence interval 23.4% to 32.2%), 19% (16.8% to 20.7%), and 12% (9.2% to 14.0%) and of mild disabilities were 38.5% (33.7% to 43.4%), 36% (33.4% to 38.1%), and 34% (30.2% to 37.4%) at 24-26, 27-31, and 32-34 weeks, respectively. Assistance at school was used by 27% (22.9% to 31.7%), 14% (12.1% to 15.9%), and 7% (4.4% to 9.0%) of children at 24-26, 27-31, and 32-34 weeks, respectively. About half of the children born at 24-26 weeks (52% (46.4% to 57.3%)) received at least one developmental intervention which decreased to 26% (21.8% to 29.4%) for those born at 32-34 weeks. Behaviour was the concern most commonly reported by parents. Rates of neurodevelopment disabilities increased as gestational age decreased and were higher in families with low socioeconomic status.
Conclusions In this large cohort of children born preterm, rates of severe/moderate neurodevelopmental disabilities remained high in each gestational age group. Proportions of children receiving school assistance or complex developmental interventions might have a significant impact on educational and health organisations. Parental concerns about behaviour warrant attention.
DOI: 10.1136/bmj.n741
Source: https://www.bmj.com/content/373/bmj.n741
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
