第22屆 極低體重早產兒認知發展的預測

極低體重早產兒認知發展的預測

Early cognitive prediction for very low birth weight preterm baby

¹陳妍廷, ¹郭煌宗*, ¹李述富,  ¹湯佳樺, ²林秀縵, ³翁岳塘, ³葉宸妤, ³許凱程, ³吳亞倫

¹Yen Ting Chen , ¹Huang-Tsung Kuo*,  ²Sot-Fu Lei, ²Chia-Hua Tang,  ¹Hsiu-Man Lin, ³Yueh-Tang Weng, ³Chen-Yu Yeh, ³Kai-Cheng Hsu, ³Ya-Lun Wu

¹中國醫藥大學兒童醫院 兒童發展及行為科 親職及兒童發展研究小組

²中國醫藥大學兒童醫院 兒童發展及行為科

³中國醫藥大學兒童醫院 人工智慧醫學診斷中心

¹ Parenting and Child Development Study Group, Division of Child Development and Behavior Pediatrics, Children’s Hospital of China Medical University

² Division of Child Development and Behavior Pediatrics, Children’s Hospital of China Medical University

³AI Center for Medical Diagnosis, China Medical University Hospital

背景與目的

        縱使新生兒醫學的進步讓早產兒死亡與疾病發生率大幅下降，仍有13-15%的極低體重早產兒受動作、認知障礙(腦性麻痺與智能障礙)的限制所苦，此研究中，我們希望能找出早期預測認知發展的正向因子，作為早期介入治療的依據。

方法

        本縱貫性研究納入自2011-2020年共146位極低體重早產兒，所有孩童皆有完整出生生理狀況、家庭社經地位與4次發展評估，包含在6, 12, 24個月的貝氏嬰兒發展量表(Bayley-III)，以及5歲時的魏氏量表(WPPSI-IV)。以相關性與回歸性分析，試圖找出早期發展與晚期認知能力的預測性因子。

結果

        本研究共有三項發現，第一是六個月時的動作發展和五歲時的認知能力具有正相關，第二是動作與認知能力的正相關性在5歲以前都持續存在，最後是兩歲時的認知與五歲時的認知開始呈現維持正相關

結論

        我們發現動作發展是最早也最穩定持續可以預測晚期認知發展的正向因子，未來臨床將能以1) 極低體重早產兒之早期動作發展可作為後期認知能力的好預測因子 2)極低體重早產兒之動作發展治療可作為改善未來認知能力的重要早期介入方向。而建議後續研究能納入足月正常體重新生兒與更大的研究基數作為對照組。

關鍵字：認知發展、預測、極低體重、早產兒、追蹤

極低體重早產兒認知發展的預測

Early cognitive prediction for very low birth weight preterm baby

¹陳妍廷, ¹郭煌宗*, ¹李述富,  ¹湯佳樺, ²林秀縵, ³翁岳塘, ³葉宸妤, ³許凱程, ³吳亞倫

¹Yen Ting Chen , ¹Huang-Tsung Kuo*,  ²Sot-Fu Lei, ²Chia-Hua Tang,  ¹Hsiu-Man Lin, ³Yueh-Tang Weng, ³Chen-Yu Yeh, ³Kai-Cheng Hsu, ³Ya-Lun Wu

¹中國醫藥大學兒童醫院 兒童發展及行為科 親職及兒童發展研究小組

²中國醫藥大學兒童醫院 兒童發展及行為科

³中國醫藥大學兒童醫院 人工智慧醫學診斷中心

¹ Parenting and Child Development Study Group, Division of Child Development and Behavior Pediatrics, Children’s Hospital of China Medical University

² Division of Child Development and Behavior Pediatrics, Children’s Hospital of China Medical University

³AI Center for Medical Diagnosis, China Medical University Hospital

Background and purpose

        Advances in neonatology have made significant progress in reducing mortalities and morbidities in this field, and yet, around 13-15% of very low birth weight preterm babies still suffer from motor (e.g. cerebral palsy) and cognitive (e.g. mental retardation) delay after delicate neonatal intensive care. The purpose of this study was to find out early prediction factors for good cognitive outcomes among those very low birth weight preterm babies.

Material and method

        A longitudinal study was done between 2011-2020, and 146 candidates were enrolled. Medical and social economic factors were all considered, while all preterm completed 4 times of developmental assessments (at age of 6m,12m, 24m, and 60m/o). The first 3 assessment instruments were Bayley-III, and the last one was WPPSI-IV. Correlation and regression statistics were performed to find out early functional status and late cognitive outcome.

Result

        There are 3 major findings found in this study, 1). Motor status has positive correlation to cognitive function in 5 years old at the very early 6 months of age, 2). Motor performance shows consistently positive correlation in all age to cognitive outcome by 5 y/o, 3). Cognitive performance in 2 y/o shows positive correlation to cognitive function in 5 years of age.

Discussion

        In this study, we found motor as the earliest and most consistent positive predictor to later cognitive function, which inspires us in two directions, 1). Early motor status as a good predictor for later cognitive development and 2). Early motor intervention is an important strategy for children with developmental delays. Further study with normal control and larger population is proposed.

Key Words: cognitive development, prediction, very low birth weight, preterm, longitudinal