Girls and Boys Born before 28 Weeks Gestation: Risks of Cognitive, Behavioral, and Neurologic Outcomes at Age 10 Years

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• 作者：Karl C.K. Kuban ; MD ; SMEpi¹ ; ^{karl.kuban@bmc.org" class="auth_mail" title="E-mail the corresponding author} ; Robert M. Joseph ; PhD² ; Thomas M. O'Shea ; MD³ ; Elizabeth N. Allred ; MS⁴ ; ⁵ ; Timothy Heeren ; PhD⁶ ; Laurie Douglass ; MD¹ ; Carl E. Stafstrom ; MD ; PhD⁷ ; Hernan Jara ; PhD⁸ ; Jean A. Frazier ; MD⁹ ; Deborah Hirtz ; MD¹⁰ ; Alan Leviton ; MD⁴ ; ⁵ ; on behalf of the Extremely Low Gestational Age Newborn (ELGAN) Study Investigators^&lowast ; ; Janice Ware ; PhD ; Taryn Coster ; BA ; Brandi Hanson ; PsyD ; Rachel Wilson ; PhD ; Kirsten McGhee ; PhD ; Patricia Lee ; PhD ; Aimee Asgarian ; PhD ; Anjali Sadhwani ; PhD ; Ellen Perrin ; MD ; Emily Neger ; MA ; Kathryn Mattern ; BA ; Jenifer Walkowiak ; PhD ; Susan Barron ; PhD ; Bhavesh Shah ; MD ; Rachana Singh ; MD ; MS ; Anne Smith ; PhD ; Deborah Klein ; BSN ; RN ; Susan McQuiston ; PhD ; Lauren Venuti ; BA ; Beth Powers ; RN ; Ann Foley ; Ed M ; Brian Dessureau ; PhD ; Molly Wood ; PhD ; Jill Damon-Minow ; PsyD ; Richard Ehrenkranz ; MD ; Jennifer Benjamin ; MD ; Elaine Romano ; APRN ; Kathy Tsatsanis ; PhD ; Katarzyna Chawarska ; PhD ; Sophy Kim ; PhD ; Susan Dieterich ; PhD ; Karen Bearrs ; PhD ; Nancy Peters ; RN ; Patricia Brown ; BSN ; Emily Ansusinha ; BA ; Ellen Waldrep ; PhD ; Jackie Friedman ; PhD ; Gail Hounshell ; PhD ; Debbie Allred ; PhD ; Stephen C. Engelke ; MD ; Nancy Darden-Saad ; BS ; RN ; CCRC ; Gary Stainback ; PhD ; Diane Warner ; MD ; MPH ; Janice Wereszczak ; MSN ; PNP ; Janice Bernhardt ; MS ; RN ; Joni McKeeman ; PhD ; Echo Meyer ; PhD ; Steve Pastyrnak ; PHD ; Julie Rathbun ; BSW ; BSN ; RN ; Sarah Nota ; BS ; Teri Crumb ; BSN ; RN ; CCRC ; Madeleine Lenski ; MPH ; Deborah Weiland ; MSN ; Megan Lloyd ; MA ; EdS ; Scott Hunter ; PhD ; Michael Msall ; MD ; Rugile Ramoskaite ; BA ; Suzanne Wiggins ; MA ; Krissy Washington ; MA ; Ryan Martin ; MA ; Barbara Prendergast ; BSN ; RN ; Megan Scott ; PhD ; Judith Klarr ; MD ; Beth Kring ; RN ; Jennifer DeRidder ; RN ; Kelly Vogt ; PhD
• 关键词：extremely low gestational age newborns ; neurological follow-up ; late childhood ; cognition ; executive function ; autism ; microcephaly ; motor impairment
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：173
• 期：Complete
• 页码：69-75.e1
• 全文大小：364 K

文摘

To compare the prevalence of cognitive, neurologic, and behavioral outcomes at 10 years of age in 428 girls and 446 boys who were born extremely preterm.

Study design

A total of 889 of 966 eligible children previously enrolled in the multicenter Extremely Low Gestational Age Newborns Study from 2002-2004 were evaluated at 10 years of age. Children underwent a neuropsychological battery and testing for autism spectrum disorder (ASD), and parents reported on their child's behavior, development, and seizures.

Results

Of the children, 28% of boys and 21% of girls exhibited moderate to severe impairment on summary measures of cognitive abilities. Boys had a higher prevalence of impairment than girls in nearly all measures of cognition, were more than twice as likely to have microcephaly (15% in boys, 8% in girls), and require more often assistive devices to ambulate (6% in boys, 4% in girls). In contrast, boys and girls had comparable risk for a history of seizure (identified in 10% of the cohort) or epilepsy (identified in 7% of the cohort). The boy-to-girl ratio of ASD (9% in boys, 5% in girls) was lower than expected compared with the overall US autism population.

Conclusions

In this contemporary cohort of children born extremely premature and evaluated at school age, boys had higher prevalence of cognitive, neurologic, and behavioral deficits than girls. The ratio of boys to girls among those with ASD deserves further study as does the perinatal environmental-genetic interactions that might contribute to male preponderance of deficits in this high-risk sample.