Læknablaðið - 15.11.2004, Blaðsíða 19

FRÆÐIGREINAR / ÞROSKI FIMM ÁRA FYRIRBURA
Litlir fyrirburar á íslandi
Niðurstöður þroskamælinga við fimm ára aldur
Ingibjörg
Georgsdóttir1
SÉRFRÆÐINGUR I BARNA-
OG NÝBURALÆKNINGUM
Evald
Sæmundsen2
SÁLFRÆÐINGUR OG SER-
FRÆÐINGUR í FÖTLUNUM
Þóra Leósdóttir2
IÐJUÞJÁLFI
Ingibjörg
Símonardóttir3
TALMBINAFRÆÐINGUR
Snæfríður
Þóra Egilson4
IÐJUÞJÁLFI
Atli Dag-
bjartsson:>’6
SÉRFRÆÐINGUR í BARNA-
OG NÝBURALÆKNINGUM
'Tryggingastofnun ríkisins,
2Greiningar- og ráðgjafarstöð
ríkisins, ’Fræðslu- og menn-
ingarsviði, Garðabæ, 4Háskól-
anum á Akureyri, ’Barnaspít-
ala Hringsins, ‘Læknadeild
Háskóla íslands.
Fyrirspurnir og bréfaskipti:
Ingibjörg Georgsdóttir,
Tryggingastofnun ríkisins,
Laugavegi 114,150 Reykjavík.
ingibjge@tr.is
Lykilurð: litlir fyrirburar,
þroski, taugaþroskamœlingar,
langtímahorfur.
Ágrip
Inngangur: Tilgangur rannsóknarinnar „Fyrirburar
- langtímaeftirlit með heilsu og þroska” var að varpa
ljósi á lífslíkur, heilsufar, þroska og langtímahorfur
lítilla íslenskra fyrirbura sem vógu minna en lOOOg
við fæðingu og bera saman við fullburða jafnaldra.
Þessi hluti rannsóknarinnar fjallar um helstu niður-
stöður þroskamælinga og niðurstöður á mati foreldra
á hegðun barna sinna.
Aðferðir: Allir 35 litlir fyrirburar áranna 1991-95
og 55 jafnaldra samanburðarbörn tóku þátt í fram-
skyggnri rannsókn á heilsu og þroska. Börnin komu
til læknisskoðunar við rúmlega fimm ára aldur á ár-
unum 1996-2001 og gengust undir mælingar á vits-
munaþroska, málþroska, og skynhreyfiþroska. Auk
þess svöruðu foreldrar barnanna spurningum um at-
ferli þeirra. Við úrvinnslu var gerður samanburður á
frammistöðu fyrirbura og samanburðarbarna.
Niðurstöður: Mælingar á vitsmunaþroska samkvæmt
Wechsler Preschool and Primary Scale of Intellig-
ence-Revised (WPPSI-R) sýndu lægri heildarniður-
stöðu hjá fyrirburum en samanburðarhópi (p<0,001).
Pessi munur var meira afgerandi á verklegum hluta
en málhluta. Mat á málþroska með Test of Language
Development-2P (TOLD-2P) sýndi að málþroska-
tala var lægri hjá fyrirburum en samanburðarbörnum
(p=0,025). Ekki kom fram munur á hópunum þegar
frammistaða þeirra á einstökum undirprófum eða
málkerfum og málþáttum var borin saman. Mælingar
á þroska með megináherslu á skynjun og hreyfing-
ar samkvæmt Miller Assessment for Preschoolers
(MAP) sýndu að heildarskor fyrirbura var lægra en
samanburðarbarna (p<0,001) og reyndist mestur
munur á skynhreyfiþáttum og skynúrvinnslu. Mark-
tækur munur kom í ljós á þremur af fimm kvörðum
matstækisins þar sem frammistaða fyrirburanna var
síðri. Niðurstöður mælinga á fínhreyfifærni með Fin-
ENGLISH SUMMARY
Georgsdóttir I, Sæmundsen E, Leósdóttir Þ, Símonardóttir I, Egilson SÞ
Extremely Low Birthweight Infants in lceland. Neurodevelopmental profile at five years of age
Læknablaðið 2004; 90: 747-54
Objective: This study was part of a geographically
defined national study on survival, health, development,
and longterm outcome of extremely low birthweight
infants (ELBW; birthweight < 10OOg) in lceland focusing
on development and neurodevelopmental measures in
comparison to a reference group.
Methods: All 35 ELBW longtime survivors born in 1991-
95 and 55 children as matched reference group were
enrolled in a prospective study on longterm health and
development. The children underwent medical examinat-
ions and neurodevelopmental testing at five years of age
in 1996-2001, and their parents answered a questionn-
aire on their behavior. Comparison was made between
ELBW infants and the reference group.
Results: Cognitive measures with the Wechsler Pre-
school and Primary Scale of Intelligence-Revised
(WPPSI-R) showed significantly lower full scale IQ scores
for the ELBW group compared to the reference group
(p<0.001). More difference was apparent between the
groups for the performance IQ than the verbal IQ. Scores
on Test of Language Development (TOLD-2P) showed
differences between the ELBW group and the reference
group on the total language quotient (p=0.025). Sign-
ificant differences were not obtained between the groups
on TOLD-2P's individual subtests, languistic features nor
linguistic systems. Total Scores on the Miller Assessment
for Preschoolers (MAP) with emphasis on sensory motor
development, were significantly lower for the ELBW
group compared to the reference group (p<0.001). Addit-
ionally, significant differences were found on three of five
subscales of the MAP. Evaluation of fine motor skills with
the Finmotorisk utvecklingsstatus 1 -7ár (FU) revealed
significant differences (p<0.001), favoring the reference
group. Parental answers on the Child Behavior Checklist
(CBCL) showed differences between the groups on three
of eight factors in favor of the reference group (p<0.001).
Conclusions: Developmental testing at five years of
age indicates that the performance of 25% of the ELBW
children in this study, is consistent with that of same
age peers. However, as a group, the ELBW children
performed significantly poorer regarding cognitive
development and sensory-motor skills when compared
to the reference group. The most prominent neurodev-
elopmental difficulties of the ELBW children were within
perceptual organization, coordination, and executive
skills. Behavior problems were not rated as significant
according to parental answers, although there were some
differences between the groups. Since a large portion of
ELBW children experiences developmental problems, it is
important to provide early intervention during preschool
years and support services and special education during
school years, to reduce the longterm effects of develop-
mental deficits.
Key words: extremely iow birthweight intants, development,
neurodevelopmental testing, longterm outcome.
Correspondance: Ingibjörg Georgsdóttir, ingibjge@tr.is
Læknablaðið 2004/90 747