摘要：据7月27日刊《美国医学会杂志》上的一则研究披露，在对出生体重极低的孩子的所进行的一项追踪随访发现，其总体慢性疾病发病率，尤其是哮喘发病率在8-14岁的年龄期间不会改变，尽管他们发生肥胖症的比率有所增加。
1990年代时对围产期治疗的变化使得出生体重极低（ELBW）的婴儿（体重低于2.2磅）的存活率有所改善。根据文章的背景资料：“学龄期的健康结果表明，与出生体重正常（NBW）的对照组相比，这些孩子慢性疾病和发育问题的发生率非常高。ELBW在青少年时期的健康报告很少，而该时期却是孩子在社交、健康和发育方面发生巨大变化的时候。”
克里夫兰凯斯西保留地大学的Maureen Hack, M.B., Ch.B.及其同事开展了一项研究，旨在检查ELBW孩子在8-14岁期间慢性疾病发病率的变化。文章的作者报告说，在以往的一项研究中，与NBW对照组相比，ELBW的孩子在8岁时的慢性疾病发病率、功能性限制比率以及特殊健康关护的需求比率都明显增高。目前的这一研究是在2004年至2009年期间开展的，其中包括了181名来自以往研究的ELBW孩子和115名NBW对照组的孩子；这些孩子有着相似的社会人口统计学背景，他们是在1992至1995年期间出生的。
在ELBW组中，慢性疾病的总体发病率在8-14岁期间没有变化（分别为75%和74%），但是每个孩子罹患的慢性疾病的平均数有了显著的降低。在功能性限制的测量上，其发生率有了显著的下降：从56%降至46%。对这两组的比较发现，在8岁时，ELBW孩子的显著增高的慢性疾病发生率及数字一直会持续到14岁（ELBW孩子为74% vs. NBW 对照组为47%）。文章的作者写道：“在14岁的时候，有46%的ELBW孩子具有功能性限制，而NBW对照组的这一数字为16%；这些功能性限制包括精神发育和情感发育延迟、对简单指令的理解以及说话和沟通等方面的障碍。”
ELBW孩子中的需要用药的哮喘病发病率在8岁至14岁期间没有变化（皆为23%）；而在NBW对照组中，哮喘的发病率在8岁至14岁期间有了明显的增加：分别为8%和17%。ELBW和NBW儿童在哮喘发病率上的差异在14岁的时候已经不再明显（分别为23% vs. 17%）。
ELBW孩子中的肥胖症发病率从8岁时的12%增加至14岁时的19%。该发病率在NBW对照组中则没有变化；在14岁时，肥胖症发病率在ELBW孩子和NBW对照组孩子之间没有显著差异。
文章的作者得出结论：“我们的结果与目前的存活者可能有关系。ELBW状态可被看作是多种慢性疾病风险的一个标志。对这些孩子的这些风险有必要在其青少年期间进行高于平均水平的更为密切的健康监控。除了对神经发育性疾病进行治疗之外，患有哮喘或肥胖症的ELBW孩子应该接受诸如防止吸烟及鼓励运动，以减少这些疾病的干预治疗以及可能的对其长期的成年时期的健康后果的改善。”
生物探索推荐英文论文摘要：
Change in Prevalence of Chronic Conditions Between Childhood and Adolescence Among Extremely Low-Birth-Weight Children
ABSTRACT
Context Extremely low-birth-weight (ELBW) children have high rates of chronic conditions during childhood. Information on their trajectory of health during adolescence is needed for health care planning.
Objective To examine changes in the rates of chronic conditions between the ages of 8 and 14 years among ELBW children compared with normal-birth-weight (NBW) controls.
Design, Setting, and Participants Cohort study conducted from 2004 through 2009 of 181 ELBW children (weight < 1 kg) and 115 NBW controls of similar sociodemographic status born from 1992 through 1995 in Cleveland, Ohio.
Main Outcome Measures Rates of chronic conditions overall (measured with the revised Questionnaire for Identifying Children With Chronic Conditions) and rates of asthma and obesity.
Results The overall rates of chronic conditions did not change significantly between the ages of 8 and 14 years among ELBW children (75% at age 8 years vs 74% at age 14 years) or NBW controls (37% at age 8 years vs 47% at age 14 years). In generalized estimating equations logistic regression adjusting for sociodemographic status, sex, and race, ELBW children continued to have a higher rate of chronic conditions than NBW controls at age 14 years (74% vs 47%, respectively, adjusted odds ratio [AOR], 2.8 [95% confidence interval {CI}, 1.7 to 4.6]). Rates of asthma requiring medication did not change between the ages of 8 and 14 years among ELBW children (23% at both ages) but increased among NBW controls from 8% at age 8 years to 17% at age 14 years (P = .002). Differences in rates of asthma between ELBW and NBW children were no longer significant at the age of 14 years (23% vs 17%, respectively; AOR, 1.5 [95% CI, 0.8 to 2.8]). Mean z scores for body mass index increased in ELBW children from 0.06 at age 8 years to 0.38 at age 14 years (P <.001) and rates of obesity increased from 12% at age 8 years to 19% at age 14 years (P = .02). However, the scores and rates did not change among NBW controls such that at the age of 14 years the differences between ELBW and NBW children in mean z scores for body mass index (0.38 vs 0.56, respectively; adjusted mean difference −0.2 [95% CI, −0.5 to 0.1]) or rates of obesity (19% vs 20%, respectively; AOR, 1.1 [95% CI, 0.6 to 2.0]) were not significant.
Conclusions Among ELBW children, rates of overall chronic conditions and asthma did not change between the ages of 8 and 14 years but the rate of obesity increased. Compared with NBW controls, the rates of chronic conditions were higher but there were no significant differences in the rates of asthma or obesity.
KEYWORDS: adolescent, asthma, child development, children's health, chronic disease, comorbidity, infant, extremely low birth weight, neurologic manifestations, obesity.
