BACKGROUND: Birth before 26 weeks of gestation is associated with a high prev alence of neurologic and developmental disabilities in the infant during the fir st two years of life. METHODS: We studied at the time of e...BACKGROUND: Birth before 26 weeks of gestation is associated with a high prev alence of neurologic and developmental disabilities in the infant during the fir st two years of life. METHODS: We studied at the time of early school age childr en who had been born at 25 or fewer completed weeks of gestation in the United K ingdom and Ireland in 1995. Each child had been evaluated at 30 months of age. T he children underwent standardized cognitive and neurologic assessments at six y ears of age. Disability was defined as severe (indicating dependence on caregive rs), moderate, or mild according to predetermined criteria. RESULTS: Of 308 surv iving children, 241 (78 percent) were assessed at a median age of six years and four months; 160 classmates delivered at full term served as a comparison group. Although the use of test reference norms showed that cognitive impairment (defi ned as results more than 2 SD below the mean) was present in 21 percent of the c hildren born extremely preterm (as compared with 1 percent in the standardized d ata), this value rose to 41 percent when the results were compared with those fo r their classmates. The rates of severe, moderate, and mild disability were 22 p ercent, 24 percent, and 34 percent, respectively; disabling cerebral palsy was p resent in 30 children (12 percent). Among children with severe disability at 30 months of age, 86 percent still had moderate to severe disability at 6 years of age. In contrast, other disabilities at the age of 30 months were poorly pre dictive of developmental problems at 6 years of age. CONCLUSIONS: Among extremel y preterm children, cognitive and neurologic impairment is common at school age. A comparison with their classroom peers indicates a level of impairment that is greater than is recognized with the use of standardized norms.展开更多
文摘BACKGROUND: Birth before 26 weeks of gestation is associated with a high prev alence of neurologic and developmental disabilities in the infant during the fir st two years of life. METHODS: We studied at the time of early school age childr en who had been born at 25 or fewer completed weeks of gestation in the United K ingdom and Ireland in 1995. Each child had been evaluated at 30 months of age. T he children underwent standardized cognitive and neurologic assessments at six y ears of age. Disability was defined as severe (indicating dependence on caregive rs), moderate, or mild according to predetermined criteria. RESULTS: Of 308 surv iving children, 241 (78 percent) were assessed at a median age of six years and four months; 160 classmates delivered at full term served as a comparison group. Although the use of test reference norms showed that cognitive impairment (defi ned as results more than 2 SD below the mean) was present in 21 percent of the c hildren born extremely preterm (as compared with 1 percent in the standardized d ata), this value rose to 41 percent when the results were compared with those fo r their classmates. The rates of severe, moderate, and mild disability were 22 p ercent, 24 percent, and 34 percent, respectively; disabling cerebral palsy was p resent in 30 children (12 percent). Among children with severe disability at 30 months of age, 86 percent still had moderate to severe disability at 6 years of age. In contrast, other disabilities at the age of 30 months were poorly pre dictive of developmental problems at 6 years of age. CONCLUSIONS: Among extremel y preterm children, cognitive and neurologic impairment is common at school age. A comparison with their classroom peers indicates a level of impairment that is greater than is recognized with the use of standardized norms.
