極低出生體重早產兒於青少年期之神經精神診斷、情緒與行為症狀、生活功能之研究

目的：極低出生體重早產兒(出生體重小於1500公克)有較高比例的神經發展障礙。本研究追蹤調查1996-1999年出生之台灣極低出生體重早產兒，以瞭解他們於青少年期之情緒與行為範疇、神經精神診斷及生活功能狀態。方法：研究追蹤南部某醫學中心之早產兒登錄系統內，1996年1月至1999年12月間出生體重低於1500克的極低出生體重早產嬰孩，共有148位符合標準。產前、週產期及新生兒之因子將由病歷紀錄提取登錄；兒童青少年精神專科醫師進行精神科會談；由家長填寫台灣版兒童行為檢核表與生活狀態問卷，以評估極低出生體重早產青少年之目前狀態。追蹤後發現37位已死亡，61位參與者/家庭填寫知情同意書以表示參與本追蹤研究，參與率約為55.0%。結果：61位參與者之平均年齡為13.4歲，52.5%為男性，13位參與者之出生體重低於1000公克(超低出生體重早產兒)。17.3%的參與者在兒童行為檢核表之整體問題向度達臨床顯著水準，在症狀量尺中，19.2%的青少年被指出在情緒或行為問題達臨床顯著水準。生活狀態問卷中，90.2%家長對自己孩子的日常表現有所擔心，16.4%目前仍持續進行相關復健計畫；26.3%目前仍依特教法而持續接受個別教育計畫。將神經精神疾病分為七類進行追蹤調查，發現50.8%參與者至少有一種神經精神疾病，23.0%則有兩種以上。整體而言，共有32.8%極低出生體重早產兒領有身心障礙手冊，本研究並將之定義為預後受限。後續使用多變項邏輯式迴歸分析後發現，新生兒敗血症與腦室內出血最可有效的預測預後受限之可能性。討論：家長陳述極低出生體重早產青少年有一定比例的情緒與行為問題、確診的神經精神診斷及需臨床關注的預後受限問題。本研究期望研究成果對發展中的正式公共政策提供重要訊息，給予極低出生體重早產孩童與家庭適當的服務。

關鍵字

情緒與行為症狀；功能表現；神經精神診斷；極低出生體重；早產；青少年

並列摘要

Objective: Very low birth weight (VLBW; birth weight <1500 g) children run a greater risk of neurodevelopmental disabilities. In this follow-up survey, we examined the emotional-behavioral domains, neuropsychiatric diagnosis and living status in a 1996-1999 birth cohort of Taiwanese infants born very-low-birth-weight (VLBW, birth weight <1500gm) at their adolescence Method: The subjects were VLBW infants as registered in the medical center Hospital in southern of Taiwan newborn registry from Jan 1, 1996 to Dec 31, 1999. In total 148 subjects were eligible. Prenatal, perinatal and postnatal conditions were retrieved from historical records. Psychiatric interview was arranged by child and adolescent psychiatrist. Child Behavioral Checklist (CBCL-Chinese version) and the Living Status Questionnaire were used for the parents to complete to assess these adolescents’ current condition. At follow-up, 37 subjects were confirmed death, and 61 subjects/families gave consents to participate in the survey. The participation rate was 55.0%. Results: Of the 61 participants, the current average age is 13.4 years, and 52.5% of them are male. 13 of them were of birth weight less than 1000gm (Extremely Low Birth Weight, ELBW). CBCLs revealed 17.3% of the subjects were of clinical significance in total Competence score. In CBCL-Syndrome Scale, 19.2% of adolescents were reported to have emotional or behavioral problems above clinical cutoff. In the Living Status Questionnaire, 90.2% of the parents worried about their children. 16.4% of the adolescents are still receiving ongoing physical rehabilitation programs; 26.3% of the adolescents were currently receiving individualized educational plans mandated by the Special Education Law. Regarding the seven categories of neuropsychiatric disorders we surveyed, 50.8% of the participants have at least one disorder, while 23.0% have two or more disorders. In total, 32.8% of the adolescents are eligible for handicap certificates, and we labeled this group as of “limited” prognosis. Multivariate logistic regression analysis revealed that neonatal sepsis and having Gr III/IV intraventricular hemorrhage were most predictive for the limited prognosis. Conclusions: There were certain percentage of adolescents born VLBW noted to have parental-reported emotional-behavioral problems, confirmed neuropsychiatric diagnosis and limited prognosis in need of clinical attention. We hope this finding will be of importance in the development of informed public policy and services for families and children born preterm with VLBW status.