中山大学公共卫生学院（深圳）Ruoqing Chen团队评估了不同胎龄出生儿童的长期神经发育预后。2024年1月24日，《英国医学杂志》发表了这一成果。

为了评估不同胎龄出生的儿童的长期神经发育预后，特别是与39-40周（足月）相比，32-33周（中度早产）和34-36周（晚期早产）的预后，研究组在瑞典进行了一项全国性队列研究。1998年至2012年间，共有1281690名出生于32+0至41+6周的无先天畸形的活产单胎儿童。

该研究主要结局为运动、认知、癫痫、听力和视觉障碍，以及16岁以下诊断的任何神经发育障碍的综合结局。使用Cox回归对研究人群和完整兄弟姐妹亚群中的父母和婴儿特征进行校正，估计风险比和95%置信区间。还评估了风险差异，以评估神经发育障碍的绝对风险。

中位随访13.1年（四分位间距9.5-15.9年），75311名（47.8/10000人-年）没有先天畸形的活产单胎婴儿至少有一次神经发育障碍的诊断：5899名（3.6/10000人-年）有运动障碍，27371名（17.0/10000人-年）有认知障碍，11870名（7.3/10000人-年）有癫痫障碍，19700（12.2/10000人-年）有视力障碍，以及20393名（12.6/10000人-年）有听力障碍。

与足月出生的儿童相比，中度或晚期早产的儿童出现任何损伤的风险更高（风险比为1.73和1.30；风险差异分别为4.75%和2.03%），运动、认知、癫痫、视觉和听力障碍风险亦更高。神经发育障碍的风险从32周（最早胎龄）开始最高，在41周之前逐渐下降，在37-38周（足月）时也高于39-40周。在兄弟姐妹比较分析中（n=349108），除胎龄、癫痫和听力障碍外，大多数相关性保持稳定，即未观察到相关性；与足月出生的儿童相比，早产儿童仅发生认知障碍的风险更高。

这项研究的结果表明，中度早产或晚期早产的儿童出现不良神经发育结局的风险更高。不应低估风险，因为这些儿童在早产儿童中所占比例最大。研究结果可能有助于专业人员和家庭实现更好的风险评估和后续行动。

附：英文原文

Title: Neurological development in children born moderately or late preterm: national cohort study

Author: Ayoub Mitha, Ruoqing Chen, Neda Razaz, Stefan Johansson, Olof Stephansson, Maria Altman, Jenny Bolk

Issue&Volume: 2024/01/24

Abstract:

Objective To assess long term neurodevelopmental outcomes of children born at different gestational ages, particularly 32-33 weeks (moderately preterm) and 34-36 weeks (late preterm), compared with 39-40 weeks (full term).

Design Nationwide cohort study.

Setting Sweden.

Participants 1281690 liveborn singleton children without congenital malformations born at 32+0 to 41+6 weeks between 1998 and 2012.

Main outcome measures The primary outcomes of interest were motor, cognitive, epileptic, hearing, and visual impairments and a composite of any neurodevelopmental impairment, diagnosed up to age 16 years. Hazard ratios and 95% confidence intervals were estimated using Cox regression adjusted for parental and infant characteristics in the study population and in the subset of full siblings. Risk differences were also estimated to assess the absolute risk of neurodevelopmental impairment.

Results During a median follow-up of 13.1 years (interquartile range 9.5-15.9 years), 75311 (47.8 per 10000 person years) liveborn singleton infants without congenital malformations had at least one diagnosis of any neurodevelopmental impairment: 5899 (3.6 per 10000 person years) had motor impairment, 27371 (17.0 per 10000 person years) cognitive impairment, 11870 (7.3 per 10000 person years) epileptic impairment, 19700 (12.2 per 10000 person years) visual impairment, and 20393 (12.6 per 10000 person years) hearing impairment. Children born moderately or late preterm, compared with those born full term, showed higher risks for any impairment (hazard ratio 1.73 (95% confidence interval 1.60 to 1.87) and 1.30 (1.26 to 1.35); risk difference 4.75% (95% confidence interval 3.88% to 5.60%) and 2.03% (1.75% to 2.35%), respectively) as well as motor, cognitive, epileptic, visual, and hearing impairments. Risks for neurodevelopmental impairments appeared highest from 32 weeks (the earliest gestational age), gradually declined until 41 weeks, and were also higher at 37-38 weeks (early term) compared with 39-40 weeks. In the sibling comparison analysis (n=349108), most associations remained stable except for gestational age and epileptic and hearing impairments, where no association was observed; for children born early term the risk was only higher for cognitive impairment compared with those born full term.

Conclusions The findings of this study suggest that children born moderately or late preterm have higher risks of adverse neurodevelopmental outcomes. The risks should not be underestimated as these children comprise the largest proportion of children born preterm. The findings may help professionals and families achieve a better risk assessment and follow-up.

DOI: 10.1136/bmj-2023-075630

Source: https://www.bmj.com/content/384/bmj-2023-075630