小于胎龄儿神经认知发育的研究进展

Research progress on the neurocognitive development of small for gestational age

小于胎龄(SGA)儿相较适于胎龄(AGA)儿有更高的神经认知发育不良发生率,本文回顾了近年来SGA儿童神经认知发育相关文献,研究显示在脑血流与脑结构方面,SGA儿童因生长受限会产生“脑保留效应”,但这并不能保障大脑的正常发育,血流受限又会造成SGA儿童脑结构的改变,包括大脑皮层、海马体和小脑在内的多个脑区域的总白质和灰质体积减少,导致头围减小。在神经认知结局方面,SGA儿童在智力、注意力、记忆力和执行功能等各个神经认知领域的评分均较低,造成学习成绩差、社交能力和行为问题的风险增加,易导致严重神经障碍,如脑瘫、癫痫和视听力障碍,并引起注意缺陷与多动障碍(ADHD)、孤独症谱系障碍(ASD)、焦虑症、抑郁症和精神分裂症等共病。在导致SGA儿童神经认知发育异常的危险因素方面,研究提示妊娠高血压、妊娠体重异常、吸烟以及追赶生长与SGA神经认知发育不良结局相关。已有研究发现改善认知发育不良的最佳干预方式包括补充营养素、持续母乳喂养、高质量的教育以及适宜的早期干预(响应式养育)。

Small for gestational age(SGA)infants are more likely to experience neurocognitive impairments compared to appropriate for gestational age(AGA)infants.This paper reviews recent research on the neurocognitive development of SGA children.SGA can lead to a"brain-sparing effect"due to growth restriction,which may affect cerebral blood flow and brain structure.However,this does not guarantee normal brain development.Restrictive blood flow can result in changes in brain structure,such as reduced total white matter and gray matter volume in various brain regions,including the cerebral cortex,hippocampus and cerebellum,ultimately leading to decreased head circumference.SGA children also exhibit lower scores in all neurocognitive domains,including intelligence,attention,memory,and executive function.This may result in poor academic performance and an increased risk of social,behavioral,and neurological problems,such as cerebral palsy,epilepsy,visual and hearing impairments,as well as comorbidities like attention deficit hyperactivity disorder(ADHD),autism spectrum disorder(ASD),anxiety,depression,and schizophrenia.Several risk factors for SGA-related neurocognitive impairments have been identified,including gestational hypertension,abnormal gestational weight,smoking,and catch-up growth.Studies have shown that the best interventions to improve cognitive dysplasia include nutrient supplementation,continued breastfeeding,high-quality education,and appropriate early intervention(responsive parenting)are effective in improving cognitive outcomes for SGA children.