低出生體重是青少年發生慢性疾病的風險因素之一


  【24drs.com】根據發表於7月27日美國醫學會期刊(Journal of the American Medical Association)的一篇研究,極低出生體重(ELBW)孩童,8-14歲時發生慢性疾病的比率高於正常出生體重者(NBW),不過,肥胖或氣喘比率並無差異。
  
  已知ELBW孩童發生慢性疾病的風險較高,但是有關這些風險隨年紀改變的資料有限,這些資料將有助於健康照護計畫;這篇在俄亥俄州克里夫蘭進行的世代研究,比較了2004-2009年間出生的181名ELBW孩童(體重< 1公斤)以及1992-1995年間出生、社會人口統計學方面相符之115名NBW對照組。
  
  凱斯西儲大學醫學中心小兒科Maureen Hack等研究者,使用改版的「Questionnaire for Identifying Children With Chronic Conditions」這項問卷確認氣喘和肥胖等慢性疾病比率。8-14歲的ELBW孩童之間,慢性疾病比率並無顯著改變:8歲時為75%[95%信心區間(CI)為68% - 81%]、14歲時為74%[95% CI,67% - 80%]);NBW之對照組的變化也是:8歲時為37% (95% CI,29% - 47%)、14歲時為47% (95% CI,38% - 56%)。
  
  14歲時,ELBW孩童的慢性疾病比率高於NBW對照組(分別是74% vs 47%;校正勝算比[AOR]為2.8;95% CI,1.7 - 4.6);ELBW孩童中,8-14歲時,需藥物治療之氣喘比率並無改變(兩個年齡層都是23%);NBW對照組的氣喘比率從8歲時的8%增加到14歲時的17%(P = .002);14歲時,ELBW和NBW這兩組之間的孩童氣喘比率並無顯著差異(分別是23% vs 17%;AOR為1.5;95% CI,0.8 - 2.8)。
  
  8-14歲時,ELBW組孩童的身體質量指數平均z分數增加(從0.06到0.38;P < .001),肥胖比率也是(從12%到19%;P = .02);14歲時,ELBW和NBW這兩組之身體質量指數平均z分數並無顯著差異(分別是0.38 vs 0.56;較正平均差異為-0.2;95% CI,-0.5-0.1);肥胖比率也無顯著差異(分別是19% vs 20%;AOR,1.1;95% CI,0.6 - 2.0)。
  
  研究限制包括,依據出生體重而非妊娠年紀,使用都市的ELBW資料而無法代表其他區域,NBW組的追蹤率比ELBW組低。
  
  研究者結論表示,ELBW狀態可視為多種慢性疾病的風險標記,必須在青少年時進行更嚴密的監測;除了神經發育異常之外,有氣喘或肥胖的ELBW孩童應接受菸害防治與鼓勵運動等介入,以減少這些狀況的後遺症,改善他們成年時的結果。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6579&x_classno=0&x_chkdelpoint=Y
  

Low Birth Rates a Risk for Chronic Conditions in Adolescence

By Jim Kling
Medscape Medical News

July 26, 2011 — Extremely low-birth-weight (ELBW) children have higher rates of chronic conditions than normal-birth-weight (NBW) control patients between the ages of 8 and 14 years, but no differences in rates of obesity or asthma, according to a study published in the July 27 issue of Journal of the American Medical Association.

ELBW children are known to be at heightened risk for chronic conditions, but little information is available on how those risks change as the children age. Such data could be useful in healthcare planning.

This cohort study, based in Cleveland, Ohio, compared 181 ELBW children (weight < 1 kg) born between 2004 and 2009 and 115 NBW control children, matched by sociodemographic status and born between 1992 and 1995.

The researchers, led by Maureen Hack, MB, ChB, from the Department of Pediatrics, Case Western Reserve Medical Center, Cleveland, used the revised Questionnaire for Identifying Children With Chronic Conditions to determine rates of chronic conditions, including asthma and obesity. There was no significant change among ELBW children in the rates of chronic conditions between the ages of 8 and 14 years (75% at age 8 years [95% confidence interval (CI), 68% - 81%] vs 74% at age 14 years [95% CI, 67% - 80%]). Nor was there a change among NBW control patients: 37% (95% CI, 29% - 47%) at age 8 years vs 47% (95% CI, 38% - 56%) at age 14 years.

At age 14 years, ELBW children had higher rates of chronic conditions compared with NBW control patients (74% vs 47%, respectively; adjusted odds ratio [AOR], 2.8; 95% CI, 1.7 - 4.6).

In ELBW children, the rate of asthma requiring medication did not change between ages 8 and 14 years (23% at both ages). NBW control patients experienced an increase in the rate of asthma from 8% at age 8 years to 17% at age 14 years (P = .002). At 14 years of age, the rate of asthma did not significantly differ between ELBW and NBW children (23% vs 17%, respectively; AOR, 1.5; 95% CI, 0.8 - 2.8).

Between ages 8 and 14 years, the mean z scores for body mass index increased in ELBW children (from 0.06 to 0.38; P < .001), as did obesity rates (from 12% to 19%; P = .02). At age 14 years, there was no significant difference between NBW control patients and ELBW 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). Obesity rates also did not significantly differ (19% vs 20%, respectively; AOR, 1.1; 95% CI, 0.6 - 2.0).

Limitations of the study include reliance on birthweight rather than gestational age, use of ELBW data from an urban setting that is not representative of or generalizable to other areas, and lower follow-up rate for the NBW group than the ELBW group.

"ELBW status may be considered a marker for the risk of multiple chronic conditions that warrant closer than average health surveillance during adolescence. In addition to therapy for neurodevelopmental disorders, ELBW children with asthma or obesity should receive interventions such as smoking prevention and exercise encouragement to reduce the consequences of these conditions and to possibly enhance their long-term adult outcomes," the authors conclude.

The study was supported by the National Institutes of Health. Dr. Hack has received honoraria from the Cleveland Clinic 2010 Contemporary Forums and from Bridgeport Hospital for lectures as well as payment for manuscript preparation from The Lancet and royalties from Cambridge Press as coeditor on a book on neurodevelopmental outcomes of preterm birth. The other authors have disclosed no relevant financial relationships.

JAMA. 2011;4:394-401.

    
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