2012-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646093摘要：雖然近三十年來周產期醫療的進步顯著提高了極低出生體重早產兒（出生體重低於1,500公克）的存活率，也對於嚴重發展障礙的發生率有小幅的改善，然而其罹患輕度發展失能（例如：學習障礙、低智力商數、注意力不足過動症、神經心理缺陷、視動協調能力不足、以及內隱性行為問題等）的比率卻升高達50-70%。過去的文獻顯示，部份西方國家設計的早產兒早期介入計劃在某些認知預後功能有短至長期的療效，但是極少數介入研究持續追蹤至學齡期的療效，並就有效的介入計劃探討其可能之神經影響途徑。本三年計畫將延續本團隊過去的介入研究，長期追蹤臺灣極低出生體重早產兒過去曾經於嬰兒期接受過早期介入（常規性照護、以門診為基礎的早期介入與以居家為基礎的早期介入）於七歲時之療效，後兩者的介入內容包含相同之兒童與父母面向的服務以及互動教導，但介入的地點則分別在新生兒科診間與早產兒家中進行。本研究將徵召過去曾經依隨機分配之原則安排至常規照護組、門診介入組或家訪介入組的178名臺灣極低出生體重早產兒，並收集與早產兒性別與母親教育程度相配合之適重足月兒做為發展對照。長期療效之評估將包括兒童與父母預後，兒童預後將包含健康、生長、認知、動作功能、行為以及學校表現/參與，神經生理評估（腦波圖/事件相關電位）將用以了解療效之可能神經影響途徑；父母預後為父母親的教養態度。本早期介入之長期療效追蹤結果，將可提供臺灣早療人員與醫療政策決策者重要的資訊，做為未來針對發展障礙高危險性早產兒設計適當有效的早期介入計劃之參考。<br> Abstract: Despite the remarkable achievements in neonatal survival of preterm infants with verylow birth weight (VLBW, birth weight < 1,500 g) over the past three decades, improvements have produced little change in their prevalence of severe developmental disability and the rate of low severity dysfunctions (e.g., learning disabilities, low IQ, attention-deficit hyperactivity disorder, specific neuropsychological deficits, poor perceptual-motor skills and internalizing behavioral problems) remains high as 50% to 70%. Few intervention programs developed for preterm infants in Western societies were shown to have short- to long-term benefits in certain cognitive functions, however rare studies have investigated intervention effect at school age and explored plausible neurological pathway for effective intervention. This three-year study is therefore aimed to extend our previous research to longitudinally examine the effectiveness of three intervention programs (clinic-based intervention program [CBIP], home-based intervention program [HBIP] and usual care program [UCP]) for VLBW preterm children in Taiwan at seven years of age. The CBIP and HBIP contained similar child- and parent-focused services as well as interaction activities but were respectively delivered at clinic for the CBIP and at home for the HBIP. A total of 178 VLBW preterm infants have been randomly assigned to the CBIP, HBIP or UCP. Gender and maternal education level matched term children with normal birth weight will also be included to serve as the reference group for comparison of developmental outcome.Effectiveness examined will include child and parent outcomes. Child outcome measures will include growth, health, cognition, motor function, behavior, and school performance/participation. Neurophysiological assessment(electroencephalogram/event-related potential) will be used to investigate the neurological pathways underlying the effective intervention. Parent outcome will be measured with parenting. The long-term effect of early intervention for preterm children will provide important information to help medical professionals and public policy makers to develop effective intervention for Taiwanese preterm children who are at risk of developmental disorders.早期介入療效神經發展腦波圖親職早產學齡期