本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-075630

摘要内容如下：

客观

评估不同胎龄出生的儿童的长期神经发育结果，特别是32-33周（中度早产）和34-36周（晚期早产），与39-40周（足月）相比。

设计

全国性队列研究。

设置

瑞典。

参与者

1998年至2012年期间，出生于32+0周至41+6周的1281690名无先天性畸形的活产单胎婴儿。

主要结果指标

感兴趣的主要结果是运动、认知、癫痫、听力和视觉障碍以及任何神经发育障碍的综合结果，诊断年龄为16岁。使用Cox回归估计风险比和95%置信区间，并对研究人群和完全同胞亚组中的父母和婴儿特征进行调整。还估计了风险差异，以评估神经发育损伤的绝对风险。

结果

在中位数为13.1年的随访期间（四分位间距9.5-15.9年），75311例（47.8/10000人年）无先天性畸形的活产单胎婴儿至少有一种神经发育障碍:5899例（3.6/10000人年）有运动障碍，27371例（17.0/10000人年）有认知障碍，11870例（7.3/10000人年）有癫痫障碍，19700例（12.2/10000人年）有视力障碍。20393人（12.6/10000人年）有听力障碍。与足月出生的儿童相比，中度或晚期早产儿童出现任何损伤的风险更高（风险比分别为1.73（95%置信区间1.60-1.87）和1.30（1.26-1.35）；风险差异分别为4.75%（95%置信区间为3.88%至5.60%）和2.03%（1.75%至2.35%））以及运动、认知、癫痫、视觉和听觉障碍。神经发育损伤的风险从32周（最早胎龄）开始最高，直到41周逐渐下降，37-38周（早期）也高于39-40周。在同胞比较分析（n=349108）中，除胎龄、癫痫和听力损伤外，大多数关联保持稳定，未观察到关联；与足月出生的儿童相比，早期出生的儿童患认知障碍的风险更高。

结论

这项研究的结果表明，中度或晚期早产儿童出现不良神经发育结果的风险更高。风险不应被低估，因为这些儿童在早产儿童中所占比例最大。研究结果可以帮助专业人士和家庭实现更好的风险评估和后续行动。

英文原文如下：

Abstracts

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  1 281 690 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), 75 311 (47.8 per 10 000 person years) liveborn singleton infants without congenital malformations had at least one diagnosis of any neurodevelopmental impairment: 5899 (3.6 per 10 000 person years) had motor impairment, 27 371 (17.0 per 10 000 person years) cognitive impairment, 11 870 (7.3 per 10 000 person years) epileptic impairment, 19 700 (12.2 per 10 000 person years) visual impairment, and 20 393 (12.6 per 10 000 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=349 108), 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.

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