早期介入對於早產兒在學齡期的動作功能、肺功能、身體活動量、行為與健康生活品質之療效

Abstract

背景與目的：早產兒是神經發展疾患的高危險群，可能伴隨負面的長期健康狀況。過去許多研究顯示早期介入對於早產兒有短期及中期的療效，不僅可以降低早產兒在新生兒時期的併發症並增加其生理穩定與成長，也有助於提升其在嬰幼兒時期的認知、動作發展與行為表現，然而目前對於長期療效的文獻則仍十分缺乏。本團隊過去建立一個臨床隨機試驗計劃，探討不同的早期介入計劃(以門診為基礎照護計劃、以家訪為基礎照護計劃、常規性照護計劃)對於極低出生體重（出生體重 < 1500公克）早產兒的療效。本篇計畫延續先前的研究，目的是要探討早期介入對於極低出生體重早產兒在學齡期的動作功能、肺功能、身體活動量、行為與健康生活品質之長期療效，並比較早產兒和足月兒在以上預後之差異。方法：本研究計劃徵召過去參與介入計畫的178名極低出生體重早產兒及62名足月兒，於9-10歲時加入追縱研究。本研究使用布魯茵克斯-歐西瑞斯基動作量表第二版評估兒童的動作功能，使用肺功能測試儀以評估兒童的肺功能，使用三維加速規紀錄器紀錄兒童在連續7日的身體活動量，使用兒童行為檢核表評量兒童的問題行為，並使用兒童健康生活品質問卷評估兒童的整體健康狀況以及對家庭的衝擊。結果：本研究共收錄62名極低出生體重早產兒，包括44名早期介入組與18名常規性照護組，以及17名足月兒。研究結果發現常規性照護組的極低出生體重早產兒在學齡期時與足月兒相比有較差的動作協調、肺功能、注意力與社交生活品質，並且其父母對於兒童有較多的擔憂。過去接受早期介入的極低體重早產兒在學齡期時則與足月兒有相似的動作功能、行為表現與健康生活品質，父母也無顯著較多的擔憂。早期介入組比常規組早產兒呈現較佳的整體動作功能(adjusted p=.002)、身體協調(adjusted p=.006) 、雙側協調(adjusted p=.01)以及平衡(adjusted p=.048)的表現，並且也改善父母對兒童的擔憂程度(adjusted p=.04)。結論：學齡期的極低出生體重兒比起足月兒童仍有較差的生理及心理健康預後，合併住院期與出院後的早期介入計畫對於極低出生體重兒的身心健康以及家庭衝擊上都有長期效益。針對早產兒的早期介入應以家庭為中心作為計畫內容設計之基礎，並於住院期間及早實施以利後續長期療效。

Background and Purpose：Infants born preterm are at risk for neurodevelopmental disorders and adverse long-term health outcomes. Previous studies have shown short- to mid-term effects of early intervention for preterm children, however, the investigation of longer-term effects was rare. Our research team designed family-centered early intervention programs for preterm infants with very low birth weight (VLBW, birth weight <1,500 g) lasting from hospitalization to one year of corrected age and demonstrated their short-term developmental benefits compared to a usual care program in a randomized controlled trial. The purpose of the present study was to examine the long-term effects of these intervention programs on motor function, lung function, physical activity, problem behaviors and health-related quality of life (HRQoL) in VLBW preterm children at school age. A group of term children served as the normative reference. Methods: One hundred and seventy-eight VLBW preterm children and 62 full-term children who had participated in our previous intervention study were recruited at 9-10 years of age. Children’s motor function was examined using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition; lung function was measured by pulmonary function test with a computerized spirometer; physical activity was recorded for seven consecutive days using an accelerometer; behaviors were assessed using the Child Behavior Checklist; HRQoL was assessed using self-report and parent-proxy report of Pediatric Quality of Life Inventory (PedsQL). In addition, family impacts due to the child’s condition was assessed using the PedsQL- Family Impact Module (version 2.0). Results: Sixty-two VLBW preterm children (44 received early intervention, 18 received usual care) and 17 full-term children completed follow-up in this study. Compared to full-term children, VLBW preterm children who received usual care programs had significantly poorer motor performance, lung function, attention and social functioning (all adjusted p<.05). VLBW preterm children under early intervention were comparable with full-term children in most outcome measures and exhibited significantly better body coordination (adjusted p=.006), bilateral coordination (adjusted p=.01), balance (adjusted p=.048) and total motor performance (adjusted p=.002) than those under usual care programs. Tendencies of intervention favoring children’s lung function, emotional behaviors and social functioning were also noted. In addition to child outcomes, positive effect of early intervention was also revealed in reducing parental distress (adjusted p=.04). Conclusion: VLBW preterm children remained to show adverse outcomes in motor performance, lung function, behaviors and social functioning at school age. Family-centered early intervention including both in-hospital and after-discharge developmental care programs was effective to enhance both physical and psychosocial health of VLBW preterm children and to reduce parental distress at school age. Family-centered early intervention programs should be provided with comprehensive child-, parent, and dyad-focused services for preterm infants to enhance long-term outcomes of children and their families.