极低出生体重儿智力发育的追踪研究

【目的】　动态研究极低出生体重儿的智力发育。　【方法】　根据儿童不同的年龄段 ,采用新版K式发育检查 (新版K式 )和韦克斯勒儿童智力发育量表 (Wppsi和Wisc R)对 176名极低出生体重儿在矫正 18个月、3岁和实足 5岁、8岁时进行智力跟踪检查。　【结果】　①在矫正 18个月时有 97名、矫正 3岁时有 10 3名、5岁时有 72名、8岁时有 30名极低出生体重儿接受智力检查。 176名儿童初诊时的智力水平为 87.5 6± 15 .78。②初诊时 ,智力正常者共 10 1名 ,占 5 7.38% ;临界和迟滞者共占 36 .93 %。在不同的年龄阶段智力障碍的发病率有所不同 ,矫正 18个月时临界状态及智力障碍分别为 31.96 %和 8.2 4%、矫正 3岁时分别为 33 .0 1%和 11.6 5 %、5岁时分别为 30 .5 6 %和 2 7.77%、8岁时分别为 2 0 .0 0 %和 10 .0 0 %。③在智力成分中 ,3岁以内 (含 )儿童的言语性与非言语性智力水平无显著性差异(P >0 .0 5 ) ;5岁以后 (含 )儿童的言语性智力则明显低于非言语性智力水平 (P <0 .0 1)。　【结论】　极低出生体重儿由于在生理解剖上的先天不足 ,可能会导致此类儿童智力发育上不同程度的障碍 ,其智力水平较正常儿童为低。而且由于学龄儿童的言语性智力水平明显低于非言语性智力水平 ,可能会导致极出生低体重儿以后     

Risk for cognitive deficit in a population-based sample of U.S. children with autism spectrum disorders: variation by perinatal health factors

BackgroundFrom 30% to 60% of children with an autism spectrum disorder (ASD) have an IQ measure that falls in the intellectual disability (ID) range. It is not well studied whether, for children within this ASD subgroup, there is variation in the risk for low IQ based on a child's perinatal risk factors.Objective/HypothesesWe assessed whether preterm delivery and term small-for-gestational-age (tSGA) were associated with various measures of cognitive deficit among children with ASDs.MethodsA sample of 1129 singleton children born in 1994 and identified through school and health record review as having an ASD by age 8 years were selected from a U.S. population-based surveillance network. Mean IQ and dichotomous IQ outcomes indicating various levels of ID were examined according to whether a child was preterm (<37 weeks' gestation) or tSGA (term delivery and birth weight <10th percentile for gestational age of a U.S. referent). Results for the total sample and within race-ethnicity/maternal education strata were adjusted for child sex and ASD subtype classification.ResultsMean IQ was significantly (p < .05) lower in children delivered preterm (69.5) than term (74.5) and tSGA (69.3) than term appropriate-for gestational age (75.3). In stratified analyses, the preterm-IQ association was significant only among non-Hispanic white (NHW) children with maternal education at birth of high school or less; adjusted mean IQ was 8 points lower among those delivered preterm (65.4) than term (73.8). Term-SGA was associated with a significant 8-point deficit in adjusted mean IQ (75.5 vs. 83.8) in NHW children with maternal education greater than high school and a 6-point deficit that approached significance (68.4 vs. 74.5, p = 0.10) in NHW children with maternal education of high school or less. Non-Hispanic black children in both maternal education groups had significantly lower mean IQs than NHW children with little variation by preterm or tSGA.ConclusionsIn children with ASDs, the risk for concurrent ID or IQ deficit is associated with both preterm delivery and tSGA; these associations may vary by race-ethnicity and SES. Further studies of ASD-ID co-occurrence and the effectiveness of intervention strategies should consider both perinatal and sociodemographic factors.     

上海市奉贤县2岁以下儿童生长评价及影响因素分析

通过对上海市奉贤县3813名3～23月儿童生长发育资料的分析发现:奉贤县儿童生长状况介于城市和郊区之间,6月内明显高于WHO平均水平,6月后则明显落后.逐步回归分析表明:3～5月组儿童生长不利因素为奶粉类、粮谷类辅食添加过早过多,疾病(贫血、腹泻、反复急性呼吸道感染等);6～11月组有利因素为家庭条件好,动物类辅食添加多、晚断奶,不利因素为奶粉添加过早、疾病;12～23月组有利因素为动物性辅食添加多、家庭条件好、蔬菜水果添加多、粮谷类添加多等,不利因素为反复急性呼吸道感染.     

Why do children from socioeconomically disadvantaged families suffer from poor health when they reach adulthood? A life-course study

The authors investigated what risk factors contribute to an excess risk of poor adult health among children who experience socioeconomic disadvantage. Data came from 1,037 children born in Dunedin, New Zealand, in 1972-1973, who were followed from birth to age 32 years (2004-2005). Childhood socioeconomic status (SES) was measured at multiple points between birth and age 15 years. Risk factors evaluated included a familial liability to poor health, childhood/adolescent health characteristics, low childhood intelligence quotient (IQ), exposure to childhood maltreatment, and adult SES. Adult health outcomes evaluated at age 32 years were major depressive disorder, anxiety disorders, tobacco dependence, alcohol or drug dependence, and clustering of cardiovascular disease risk factors. Results showed that low childhood SES was associated with an increased risk of substance dependence and poor physical health in adulthood (for tobacco dependence, sex-adjusted relative risk (RR) = 2.27, 95% confidence interval (CI): 1.41, 3.65; for alcohol or drug dependence, RR = 2.11, 95% CI: 1.16, 3.84; for cardiovascular risk factor status, RR = 2.55, 95% CI: 1.46, 4.46). Together, the risk factors studied here accounted for 55-67% of poor health outcomes among adults exposed to low SES as children. No single risk factor emerged as the prime explanation, suggesting that the processes mediating the link between childhood low SES and adult poor health are multifactorial.     

Growth in early life and childhood IQ at age 11 years: the Newcastle Thousand Families Study

BACKGROUND: It has been suggested that in addition to genetic factors, fetal and post-natal growth influence childhood cognition, although it is unclear whether such an effect continues throughout childhood. This study aimed at investigating the potential relationships between childhood IQ at age 11 years and birth weight and height at the ages of 9 and 13 years, after adjusting for the confounding factors available to this investigation. METHODS: The Newcastle Thousand Families study, a prospectively followed cohort, originally consisted of all 1142 births in the city of Newcastle in May and June 1947. Using data on 733 members of this cohort, we investigated the associations between IQ at age 11, and birth weight and height at ages 9 and 13 years. RESULTS: Birth weight showed no association with childhood IQ. However, height at age 9 years was a significant predictor of childhood IQ after adjusting for socioeconomic status (standardized regression coefficient b = 2.6, 95% CI 1.6-3.6, P < 0.0001). Height at age 13 was also a significant predictor of IQ after adjusting for socioeconomic status (b = 3.4, 95% CI 2.3-4.4, P = 0.001), and explained an additional 2.5% of the variation in IQ scores to that already explained by socioeconomic status and height at age nine. CONCLUSIONS: These results suggest a continuing effect of post-natal growth on childhood cognition beyond the age of 9 years. Post-natal growth, which may be influenced by genetic factors and nutrition and socioeconomic circumstances in childhood, may be more important than fetal growth in terms of childhood cognition.     

Effects of transient neonatal hyperthyrotropinemia on intellectual quotient and psychomotor performance

Transient neonatal hyperthyrotropinemia (TNH) occurs frequently in areas of iodine deficiency. To evaluate the effect of TNH in intellectual function and psychomotor performance, a historical cohohrt study was performed in 9 years old children with documented TNH at birth. 18 children with TNH who had been born in Mahdieh Hospital were studied at age 9 and compared to 19 matcheal children born at the same time, but having normal thyroid function at birth. Global intelligence (IQ) and psychomotor performance were evaluated with Raven and Bender-Gestalt tests, respectively. Total serum T4 and T3 by commercial RIA and TSH by IRMA. Urine was tested for iodine content by digestion method. Height and weight were similar in two groups at birth and at 9 years of age. Thyroid function tests were similar in the two groups except for TSH at birth which was higher in TNH than in control group (23.4 +/- 8.3 vs 3.6 +/- 1.0 mU/L, P < 0.001). Results of T4, T3, resine uptake, and urinary iodine at 9 years of age were not different between two groups. Mean IQ was 98 +/- 11 and 106 +/- 8 in TNH and normal children, respectively (P < 0.01). There was no significant difference between psychomotor performance in the two groups. There was no correlation between TSH at birth and IQ at 9 years of age. The present finding suggests that TNH can adversely affect longterm intellectual development.     

A study of school children who had identified virus infections of the central nervous system during infancy

Forty-nine children who had a virus infection of the central nervous system (CNS) when under 1 year of age were studied. One child had died during the initial illness and three of the survivors were severely disabled. The other survivors, more than 5 years after the initial illness, were all attending normal schools. These 45 children, together with 45 matched controls, were examined. We confirm the findings of other studies that virus infections of the CNS in infancy may cause severe disabilities in some cases, and may depress intellectual abilities in others, even though they appear to have recovered fully. Many of the children who had a virus infection of the CNS in infancy had adverse birth and social histories and so were exceptionally vulnerable, but these factors did not account fully for the findings, and when their influence was included in the analysis, the index children still had a mean performance IQ (WISC) 6 points lower than the control children (P less than 0.05), whereas there was less than 1 point difference between the verbal IQs. Attention is drawn to the problem of virus infections in neonatal units.     

Causal pathways to infant mortality: linking social variables to infant mortality through intermediate variables

Using a conceptual model that integrates social and biomedical models of causation, this paper delineates the pathways through which social factors ultimately influence infant mortality in the African-American community. Two social factors, maternal education and marital status, are shown to influence the risk of infant death through the following intermediate variables: bio-demographic (maternal age, birth order, birth interval and outcome of last pregnancy), health care (prenatal care utilization) and proximate infant health status at birth (preterm delivery and low birth weight). While the impact of maternal education is largely explained by the intermediate variables, marital status remains a significant, albeit a weak, predictor net of all other variables.     

Determinants of Cognitive Development of Low SES Children in Chile: A Post-transitional Country with Rising Childhood Obesity Rates

Studies conducted in developing countries have noted associations between concurrent stunting, social-emotional problems and poor cognitive ability in young children. However, the relative contribution of these variables in Latin America is likely changing as undernutrition rates decline and prevalence of childhood obesity rises. We conducted a cross-sectional study of 106 normal-weight and 109 obese preschool children to compare the relative contribution of early nutrition, sociodemographic factors and psychosocial variables on cognitive development in normal-weight and obese preschool children in Chile. The study variables were categorized as: (1) socio-demographic (age, sex, birth order and socioeconomic) (2) early nutrition (maternal height, birth weight, birth length and height at 5 years) (3) psychosocial factors (maternal depression, social-emotional wellbeing and home space sufficiency). In order to assess determinants of cognitive development at 4–5 years we measured intelligence quotient (IQ); variability in normal children was mostly explained by socio-demographic characteristics (r² = 0.26), while in obese children early nutritional factors had a significant effect (r² = 0.12) beyond socio-demographic factors (r² = 0.19). Normal-weight children, who were first born, of slightly better SES and height Z score >1, had an IQ ≥ 6 points greater than their counterparts (p < 0.05). Obese children who were first born with birth weight >4,000 g and low risk of socio-emotional problems had on average ≥5 IQ points greater than their peers (p < 0.05). We conclude that in Chile, a post-transitional country, IQ variability of normal children was mostly explained by socio-demographic characteristics; while in obese children, early nutrition also played a significant role.     

延安市7～13岁儿童身高分布特点调查

摘要:目的　了解延安市学龄儿童身高分布特点,为当地儿童健康发展提供参考。方法　整群抽样延安市城区和郊区各3所小学,测量儿童身高,分析身高的年龄、性别、城郊分布特点,并与2005年中国9市儿童体格调查数据进行比较,计算矮小症患病率。结果　延安市7～13岁儿童身高均随年龄的增长而增加,各年龄段平均身高与2005年中国九市儿童标准相比,存在一定差异,随着年龄增大差距有增大趋势（P＜0.05）;8岁之前及12岁之后,城区男生身高明显高于女生;9岁之前郊区男生身高高于女生;城区男生10岁以后身高明显高于郊区男生;9～11岁城区女生身高显著高于郊区女生;延安市7～13岁儿童矮小症粗患病率为9.57%,郊区高于城区（P＜0.05）。结论　延安市7～13岁儿童身高普遍落后于全国平均水平,矮小症粗患病率达9.57%,郊区高于城区。     

Preschool and school age activities: comparison of urban and suburban populations

The objective of this study was to compare urban and suburban preschool and school age activities. A prospective survey using a convenience sample was conducted at one urban and one suburban primary care pediatric office. Questionnaires were completed for 66 urban preschool children, 70 suburban preschool children, 57 urban school age children and 61 suburban school age children during the school year. Also, questionnaires were completed for 63 suburban school age children during the summer. The suburban preschool children spent more time outdoors, were read to more frequently, visited the library more frequently and more often attended summer camp. The suburban school age children spent more time outdoors, more frequently participated in a community sport league and more often attended summer camp. The urban school age children watched more television or videos. During the summer, suburban school age children spent more time outdoors, while during the school year, suburban school age children used the library more frequently. Important differences exist between the activities of urban and suburban children in two practices in the New York metropolitan area. Pediatricians caring for urban children may have an important opportunity to promote participation in sports and educational activities.     

厦门市学龄前儿童营养不良发生率分析

目的:了解厦门市2～6岁学龄前儿童营养不良的患病情况,提出有效防治措施,改善儿童营养状况,促进生长发育。方法:按随机整群抽样的方法选择厦门市城区34所幼儿园2～6岁儿童9 517名,进行身高和体重的测量。依据世界卫生组织(WHO)推荐的Z评分方法,对营养不良进行分型和分度,由调查人员对患儿母亲进行问卷调查,了解各种营养不良的病因。结果:厦门市2～6岁学龄前儿童中度以上营养不良的患病率为0.91%,其中低体重检出率为0.34%,生长发育迟缓检出率为0.21%,消瘦检出率为0.37%。男性儿童营养不良检出率明显高于女性儿童(P<0.05)。但各年龄组间营养不良患病率无统计学差异(P>0.05)。影响因素有疾病因素、不良饮食习惯、喂养方式、出生体重等。结论:①厦门市城区学龄前儿童营养状况较好,低体重率、生长迟缓率、消瘦率均低于全国平均水平。②营养不良是多因素相互作用的结果,应进行综合防治。     

Factorial Invariance in Preventive Intervention: Modeling the Development of Intelligence in Low Birth Weight, Preterm Infants

The paper addresses the issue of measurement invariance in the analysis of preventive intervention data. Procedures for testing the invariance of covariance matrices, measurement models, and structural growth models are illustrated using data from an early intervention program for low birth weight, preterm infants. Intelligence Quotient (IQ) measured at 5 time points was modeled using piecewise growth curve analysis. Change over time in children's cognitive development was modeled separately for the pre- and postintervention periods. The first period was during the intervention, which lasted from birth through age 3 years. The second was during the postintervention period, which included follow-up assessments at ages 5 and 8 years. The analytical approach is illustrated with findings indicating that the development of IQ was different for higher low birth weight (HLBW: 2001–2500 g) and lower low birth weight (LLBW: <2001 g) infants. Examination of the effects of covariates on the IQ trajectories associated with the two birth weight groups indicated differential effects on IQ depending on the period of development and birth weight. Neonatal health and maternal age were predictors of IQ change in the LLBW group whereas maternal education was related to change in the HLBW group. During the posttreatment period, only Hispanic ethnicity and treatment group status were related to change. Hispanic participants exhibited an accelerated trajectory between program end and age 8 years. Intervention recipients exhibited a flatter trajectory during the same time period whereas participants in the control group exhibited an accelerated development, essentially catching up with their counterparts in the treatment group. Results clearly illustrate the utility of invariance testing in modeling developmental trajectories in response to preventive intervention.     

上海市婴幼儿血铅水平与体格发育的关系

目的探讨低水平铅暴露对儿童体格发育的影响。方法在上海市5个区县30所托幼机构,对1969名儿童进行了血铅水平的流行病学调查和体格发育等指标测量,并根据儿童身高、体重、头围和胸围计算其Z标准分,然后与血铅水平进行相关分析和逐步回归分析。结果上海市儿童血铅水平几何均数为0．400μmol／L,≥0．483μmol／L的比例为37．8％,血铅水平的几何均数与儿童身高、体重及头围的Z标准分呈显著的负相关。结论低水平铅暴露对上海市婴幼儿的体格发育可能具有不利影响。     

西安市1月~7岁儿童体格发育现状

目的 了解西安市1月~7岁儿童体格发育现状,以对儿童生长发育提供科学的健康指导方案。方法 采用分层整群抽样方法,调查西安市2015年1月-7岁儿童体格发育状况,调查指标包括体重、身高(身长)、头围、坐高、胸围和腰围,按年龄分21个调查组调查,共调查25 997人。结果 各项指标年龄越小增长速度越快,其中1月~3岁各年龄组间身高增长差异相对较大,3~7岁各年龄组间体重、胸围变化范围相对较大。男女各年龄组各指标在城区、郊区、郊县差异有统计学意义,主要表现在1~3月的体重、15月以上的身高、1~5月的头围、3~7岁各年龄组胸围和腰围。除5.5岁组女童外,体重、身高、坐高男女各年龄组均高于九市调查结果,头围、胸围和腰围略低于九市调查结果。男女各年龄组儿童身高、体重指标与WHO指标比较,年龄别体重,年龄别身高Z值均高于WHO标准,Z值在0.40~1.19之间。结论 西安市1月~7岁儿童体格生长发育城郊仍存在差异;体格发育水平在国内处于较高水平,也高于WHO公布的标准。     

母亲孕早期血红蛋白水平与学龄前儿童智力发育的关系

目的 探讨母亲孕早期血红蛋白(Hb)水平对学龄前儿童智力发育的影响.方法 研究对象为浙江、江苏省13市(县)在1993-1996年期间分娩的妇女,2000-2001年对这些妇女所生育的儿童(平均68月龄)随机抽样,共得到3609个母子对.使用中国-韦氏幼儿智力量表对儿童进行智力测试;母亲孕早期的Hb浓度在首次产前检查时获得.分析母亲孕早期Hb浓度与所生儿童全量表智商、语言智商和操作智商得分之间的关系.结果 孕早期贫血组妇女所生儿童的语言智商、操作智商以及全量表智商得分,比非贫血组妇女所生儿童的智商得分分别高0.6、0.9和0.8分.调整儿童性别、智力测量时月龄、地区、产次以及母亲智商、文化程度、职业等因素后,未发现母亲孕早期贫血与儿童低语言智商、操作智商和全量表智商的风险之间存在统计学联系.按照每20个百分位间隔将妊娠期妇女孕早期Hb分成5组分析,Hb浓度偏低组(Hb＜103 g/L)、中等组(110 g/L≤Hb＜116 g/L)、偏高组(Hb≥124g/L)妇女所生儿童的语言智商得分分别为91.6±18.9、92.8±18.2、90.3±18.6;操作智商得分分别为104.7±15.2、104.5±14.3、103.5±15.1,全量表智商得分分别为97.8±17.3、98.4±16.3、96.4±17.4.调整混杂因素后,孕早期Hb偏高组妇女所生儿童低语言智商及低全量表智商得分的风险分别比孕早期Hb中等浓度组妇女所生儿童高54%(OR=1.54,95%CI:1.13～2.11)和53%(OR=1.53,95%CI:1.10～2.12),但未发现与儿童低操作智商得分风险存在统计学关联.母亲孕早期低Hb水平与儿童低语言、操作或全量表智商风险之间不存在统计学联系.结论 母亲孕早期过高的Hb浓度可能对其所生子女的语言智商有不利影响.     

An inverse relation between blood pressure and birth weight among 5 year old children from Soweto, South Africa.

STUDY OBJECTIVE: To examine the relation between birth weight and blood pressure at 5 years in a cohort of South African children. DESIGN: Prospective cohort study. PARTICIPANTS: 849 five year old children. SETTING: Soweto, a sprawling urban area close to Johannesburg, South Africa, which was a designated residential area for people classified as "black" under apartheid legislation. MAIN RESULTS: Systolic blood pressure at 5 years was inversely related to birthweight (r = -0.05, p = 0.0007), independent of current weight, height, gestational age, maternal age or socioeconomic status at 5 years. There was no relation between birth weight and diastolic blood pressure. After adjusting for current weight and height, there was a mean decline in systolic blood pressure of 3.4 mm Hg (95% confidence intervals 1.4, 5.3 mm Hg) for every 1000 g increase in birth weight. CONCLUSIONS: These data from a disadvantaged urbanised community in Southern Africa extend the reported observations of an inverse relation between birth weight and systolic blood pressure. The study adds to the evidence that influences in fetal life and early childhood influence systolic blood pressure. Further research is required to assess whether efforts to reduce the incidence of low birthweight babies will attenuate the prevalence of hypertension in future generations.     

上海市0～6岁儿童体格发育的研究

目的：了解上海市儿童生长发育的状况和变化趋势。方法：采用整群抽样，对全市20个区县的25132名儿童进行体重、身高、头围、胸围、坐高等体格发育指标调查，并与1985、1975年资料进行比较。结果：体格发育水平1995年较1985、1975年有明显增重和增高，市区与郊县相比，仍有差异，市区高于郊县。本次结果与世界卫生组织（WHO）标准相比较，市区基本接近WHO标准，郊县仍有相当差距。     

Employment and low birth weight in black women.

Recent studies have not shown adverse effects of employment during pregnancy on the pregnancy outcome, but most have not successfully distinguished factors due to work-related physical and mental strain from differences in social, economic and cultural characteristics between employed and non-employed women. We analyzed data from the Alameda County Case-Control Study of Low Birth Weight to address the question of employment as a risk factor for low birth weight in more depth. Subjects in the study were singleton infants without congenital malformations born in 1987 to black or white, non-hispanic residents of Alameda County, a large urban community in California. Cases were all infants weighing less than 2500 g at birth; controls were chosen at random from the infants weighing 3000 g or more. The mothers of 377 black cases, 389 black controls, 233 white cases and 239 white controls could be located and interviewed. This analysis excluded the white women because evidence of response bias in regard to employment was found for them but not for black women. The percentage of black women in the study who were employed during pregnancy was 49.9%. Employment was associated with a significantly lower relative risk of low birth weight before and after controlling for age, parity, smoking, heavy alcohol use, prior low birth weight infants and low pre-pregnancy weight. After adjustment for known risk factors for low birth weight, employment explained more of the variance of low birth weight than other commonly used measures of 'social class', including income, education and marital status.(ABSTRACT TRUNCATED AT 250 WORDS)