Предикторы когнитивных нарушений и возможности их профилактики у недоношенных детей

В статье обобщены материалы современных публикаций, посвященных когнитивному развитию недоношенных детей во взаимосвязи с перинатальными факторами и условиями воспитания. Ведущими предикторами риска когнитивных нарушений у детей, родившихся преждевременно, являются глубокая незрелость к моменту рождения (гестационный возраст менее 27 нед) и потребность в интенсивной терапии в первые недели жизни. Приведены данные лонгитудинальных наблюдений за развитием недоношенных детей до достижения ими взрослого возраста, в которых изучена структура когнитивных нарушений в этой популяции. Обнаружено преобладание нарушений усвоения математики, а также оперативной памяти и целенаправленной деятельности; частота этих когнитивных нарушений связана как со степенью недоношенности, так и с социальным неблагополучием семьи. Современные методы нейровизуализации (диффузно-взвешенная и функциональная магнитно-резонансная томография (МРТ) мозга) позволяют уже в возрасте 18 мес определить у ребенка нарушения формирования нейронных сетей (коннектом) как морфологический субстрат когнитивных нарушений, что позволяет прогнозировать индивидуальную траекторию его развития и проводить направленные корригирующие вмешательства.

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