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Gepubliceerd in: Neuropraxis 5/2013

01-10-2013 | Artikelen

Ontwikkelingsrisico’s van ‘matig te vroeg’ geboren kinderen

Auteurs: Mw. dr. Jorien Kerstjens, prof. dr. Symen Reijneveld, mw. dr. Andrea De Winter, prof. dr. Arend Bos

Gepubliceerd in: Neuropraxis | Uitgave 5/2013

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Samenvatting

In Nederland wordt zeven tot acht procent van alle kinderen te vroeg geboren, en 75 tot 85 procent hiervan betreft matig te vroeg geboren kinderen (32-36 weken zwangerschapsduur, matig-vroeggeborenen). Lang is gedacht dat matig-vroeggeborenen geen blijvende gevolgen van hun vroeggeboorte zouden ondervinden, in tegenstelling tot veel te vroeg geboren kinderen (ernstig-vroeggeborenen < 32 weken zwangerschapsduur). Daarom heeft ontwikkelingsonderzoek zich internationaal vooral gericht op de groep ernstig-vroeggeborenen.
De resultaten van het Pinkeltje-onderzoek, een grote Nederlandse prospectieve cohortstudie, laten zien dat 8,3 procent van de matig-vroeggeborenen volgens de Ages and Stages Questionnaire (ASQ) ontwikkelingsproblemen had bij aanvang van school. Voor op-tijd-geboren kinderen was dit 4,3 procent en voor ernstig-vroeggeborenen 14,9%. Ontwikkelingsproblemen betroffen de domeinen fijne motoriek, communicatie en persoonlijk-sociaal functioneren. De relatie tussen afnemende totale zwangerschapsduur (per week tussen 25-36 weken) en kans op ontwikkelingsproblemen op vierjarige leeftijd was exponentieel voor alle onderzochte ontwikkelingsdomeinen, en veranderde niet na correctie voor confounders.
Wat betreft antenatale factoren hingen obesitas van de moeder, intra-uteriene groeiachterstand, mannelijk geslacht en het zijn van meerling samen met ontwikkelingsproblemen voor matig-vroeggeborenen. Wat betreft postnatale factoren was dit alleen hypoglykemie. Daarnaast hadden de matig-vroeggeborenen op zevenjarige leeftijd jaar lagere scores op testen voor performale intelligentie (visuospatieel redeneren) aandacht en executieve functies dan op-tijd-geboren kinderen.
Concluderend verhoogt ook matig (4-8 weken) te vroeg geboren worden het risico op ontwikkelingsproblemen. In absolute aantallen zijn er in Nederland waarschijnlijk minstens twee keer zoveel matig-vroeggeborenen als ernstig-vroeggeborenen die ontwikkelingsproblemen hebben op de leeftijd van vier jaar. De groep van matig-vroeggeborenen verdient meer aandacht dan dat ze tot nu toe heeft gekregen.
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Metagegevens
Titel
Ontwikkelingsrisico’s van ‘matig te vroeg’ geboren kinderen
Auteurs
Mw. dr. Jorien Kerstjens
prof. dr. Symen Reijneveld
mw. dr. Andrea De Winter
prof. dr. Arend Bos
Publicatiedatum
01-10-2013
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Neuropraxis / Uitgave 5/2013
Print ISSN: 1387-5817
Elektronisch ISSN: 1876-5785
DOI
https://doi.org/10.1007/s12474-013-0026-8

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