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學校名稱	輔仁大學
系所名稱	公共衛生學系
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學號	493926198
研究生(中)	王文利
研究生(英)	Wang Wen-Li
論文名稱(中)	早產與低出生體重兒之國中基測成績表現
論文名稱(英)	Performance of The Basic Competence Test for Junior High School Students among Preterm and Low Birth weight Infants
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指導教授(中)	李中一
指導教授(英)	Chung-Yi LI
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學位類別	碩士
畢業學年度	94
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語文別	中文
關鍵字(中)	低出生體重足月兒、足體重早產兒、低出生體重早產兒、國中基測
關鍵字(英)	term low weight birth、preterm normal birth weight、 preterm low birth weight、Bctest
摘要(中)	中文摘要研究目的：本研究利用非同期世代研究設計探討我國早產與低出生體重兒是否因出生特性而影響其日後參加國中學生基本學力測驗（以下簡稱基測）之成績表現，同時也探討家庭社經狀況是否與早產或低出生體重間產生明顯的交互作用，具體而言，本研究分析探討低出生體重足月兒（＜2500公克）、足體重早產兒（＜37週）、低出生體重早產兒（＜2500公克且＜37週）及正常出生體重之足月產嬰兒，在國文、英文、數學、社會、自然與總分等基測成績落於較優（＞75百分位）或較差（≦25百分位）之勝算比與95％信賴區間，以及其勝算比否會隨父母親教育程度而有所不同。材料與方法：本研究利用全國出生嬰兒資料庫與國中基測進行串檔，蒐集1985年9月1日至1990年8月31日期間出生嬰兒參加第一次國中基測之考生成績資料，並利用多變量多名義邏輯斯迴歸模式在控制性別、出生胎次、出生胎別、出生月份、父母親年齡、父母親教育程度、出生身份、現在及出生居住地區等潛在干擾因素後，計算三組暴露組（低出生體重足月兒、足體重早產兒及低出生體重早產兒）相對於對照組嬰兒（正常妊娠週數及出生體重）其基測成績落於較差以及較優之調整勝算比。此外，再按父親或母親較高的教育程度並進行分層分析，在評估父母親教育程度是否對出生特性（即出生體重與妊娠週數）基測成績的相關性產生效果修飾作用。結果：本研究在控制潛在干擾因素後發現，其低出生體重足月兒與低出生體重早產兒各科基測平均成績較對照組嬰兒低了1~2分，而基測成績總分之平均值則是低了約11~12分，而在後天父母親教育程度之效果修飾作用部份，發現低出生體重足月兒與低出生體重早產兒兩暴露組研究樣本在基測總分落於較差之勝算，隨著父母的教育程度增加有略微下降之線性之趨勢但不明顯，但反觀足體重早產兒則是隨著父母教育程度增加與對照組嬰兒成績趨於一致，另外，將出生體重與妊娠週數分層分析發現，低出生體重早產兒（妊娠週數32~＜37且出生體重＜1000公克）基測總分落於較差之勝算比3.16（95％CI=1.31-7.64）為最高。上述有關妊娠週數及出生體重對基測成績之影響在單一科別上也有類似發現。結論與建議：有研究指出幼年時期的低智力將會影響到中老年時期的智力。本研究結果發現低出生體重足月兒與低出生體重早產兒在基測成績，明顯低於正常出生體重之足月產嬰兒，並且此影響並不容易後天父母教育程度高低所影響，因此，預防低出生體重嬰兒發生，應是預防青少年較差基測成績之根本方法，本研究數據也指出：出生體重對基測成績之影響大於妊娠週數。關鍵詞：低出生體重足月兒、足體重早產兒、低出生體重早產兒、國中基測
摘要(英)	Abstract BACKGROUND AND PURPOSE：This study investigates if the birth characteristics of students with low birth weight or preterm birth influence on their performances in The Basic Competence Test for Junior High School Students (Bctest) by non-concurrent cohort study design. This study also focuses on the interactions between familial financial security and preterm birth or low weight birth. In whole, our study analyzes the performances of students with term low weight birth (<2500 gm), preterm normal birth weight (<37 weeks), preterm low birth weight (< 2500 gm and <37 weeks), and term normal birth weight birth in Chinese, English, mathematics, social science, and science, respectively, in Bctest. We examine if their scores percentile greater than 75 or less than 25 with 95% confidence interval, and if their odds ratio changes with the educational level of their parents. METHODS：This study utilizes national newborn information bank and correlates with the Bctest scores. We collecte the Bctest scores of students who were born between September 1, 1985 and August 31, 1990. Multiple multinomial logistic regression models were applied to control the potential interferencing factors such as sex, birth order, single-birth or multiple-birth, birth month, ages of parents, educational level of parents, birth identity, current living place, and birth place. We found the performances of three exposed groups (term low weight birth, preterm normal birth weight, and preterm low birth weight) got lesser percentiles and better adjusted odds ratios, compared to control groups (term normal birth weight birth.). Besides, we evaluate if the eductiaonal level of their parents modifies the correlations between birth characteristics (birth weight and pregnancy terms) and the performances in Bctest by stratified analysis of the higher educational level of the father or mother. RESULTS：This study indicates that after the interferencing factors being controlled, the average scores of students who were born with term low birth weight or preterm normal birth weight in each subject in Bctest are 1~2 marks lower than the control groups. And the total scores in Bctest are 11~12 marks lower, too. As for the modifications of educational level of the parents, we found two exposed groups of term low birth weight and preterm low birth weight falling on lesser odds ratio of total scores in Bctest. Their odds ratios decrease slightly but not remarkably by linear trend if higher of the educational level of the parents. On the other hand, the total scores of the premature birth group tend to be similar with that of the control groups when higher of the educational level of the parents. Furthermore, stratified analysis of birth weight and gestational age shows that students with preterm low birth weight (gestational age 32~ <37 weeks and birth weight <1000 gm) got lesser total scores in Bactest and falls on the highest odds ratio 3.16 (95％CI=1.31-7.64). Above-mentioned influences of gestational age and birth weight on respective subject in Bactest have similar findings, too. CONCLUSION：Some study shows that low intelligence in childhood will affect the intelligence when in middle and old age. This outcome of our study shows that students with term low birth weight or preterm low birth weight got remarkably lower scores in Bctest than students with term normal birth weight. Besides, this finding is not easily affected by educational level of their parents. Therefore, prevention of low birth weight birth is the essential method to avoid students having poor performance in Bctest. Furthermore, the study shows that the influence of birth weight on the performance in Bctest is greater than the gestational age. Key words：term low weight birth、preterm normal birth weight、 preterm low birth weight、Bctest
論文目次	目錄中文摘要……………………………………………………………………………...I 英文摘要…………………………………………………….…………………… III 壹、前言 1 一、研究背景 1 二、研究目的 2 貳、文獻探討 4 一、早產與低出生體重兒之現況及生長發展相關因素 4 二、早產與低出生體重兒因腦神經發展障礙所造成之影響 6 三、早產與低出生體重兒之學習障礙的影響 8 四、胎兒設定理論 10 五、早產與低出生體重兒之認知功能與智商 12 六、父母社經背景對早產極低出生體重兒生長發育之影響 14 七、總結 17 參、材料與方法 18 一、出生登記資料之內容與偵錯 18 二、國民中學學生基本學力測驗（基測）資料 19 三、國中基本學力量尺分數的建立 19 四、研究資料之定義 20 五、研究世代篩選及資料處理流程 22 六、統計分析 23 肆、結果 26 一、研究世代基本資料特性 26 二、研究樣本於2001~2005年各科基測成績分佈特性 28 三、研究樣本於2001~2005年各科基測之平均值與標準差 32 四、研究樣本不同出生特性與父母親教育程度別樣本基測平均值之比較 34 五、研究樣本於2001~2005年各組樣本基測成績落於較優或較差勝算比 39 六、研究樣本於2001~2005年依父母親教育程度分層後各組樣本基測成績落於較優或較差之勝算比 43 七、按SGA、LGA與AGA樣本於2001~2005年基測成績落於較優或較差之勝算比 51 八、按研究樣本出生體重及妊娠週數進一步細分後各組樣本基測成績總分落於較優或較差之勝算比 53 伍、討論與結論 55 一、本研究之主要發現 55 二、早產與低出生體重兒對日後學習及認知之影響 57 三、後天社經狀況對先天生物學異常因素之效果修飾作用 60 四、本研究限制及方法上之優點 61 五、本研究所提出之建議 63 六、結論 65 陸、參考文獻 66 表目錄………………………………………………………………………………… 75 表1：研究樣本基本特徵之描述性統計 75 表2：研究樣本於2001~2005學年度各科基測成績之四分位數分佈 77 表3：研究樣本於2001~2005學年度各科基測成績之平均值與標準差 79 表4：各組研究樣本之父母教育程度別於2001~2005年各科基測成績之平均值與標準差 80 表5：不同出生特性與父母親教育程度別樣本基測國文科平均值之比較 81 表6：不同出生特性與父母親教育程度別樣本基測英語科平均值之比較 82 表7：不同出生特性與父母親教育程度別樣本基測數學科平均值之比較 83 表8：不同出生特性與父母親教育程度別樣本基測社會科平均值之比較 84 表9：不同出生特性與父母親教育程度別樣本基測自然科平均值之比較 85 表10：不同出生特性與父母親教育程度別樣本基測總分平均值之比較 86 表11：各組樣本基測成績落於較差（≦25百分位）或較優（＞75百分位）之勝算比及其95﹪信賴區間 87 表12：各組樣本之父母親教育程度別於2001~2005年基測成績落於較差（≦25 百分位）或較優（＞75百分位）之勝算比及其95﹪信賴區間 88 表13：父母親教育程度別各組樣本國文科基測成績落於較差（≦25百分位）或較優（＞75百分位）之勝算比及其95﹪信賴區間 91 表14：父母親教育程度別各組樣本英語科基測成績落於較差（≦25百分位）或較優（＞75百分位）之勝算比及其95﹪信賴區間 92 表15：父母親教育程度別各組樣本數學科基測成績落於較差（≦25百分位）或較優（＞75百分位）之勝算比及其95﹪信賴區間 93 表16：父母親教育程度別各組樣本社會科基測成績落於較差（≦25百分位）或較優（＞75百分位）之勝算比及其95﹪信賴區間 94 表17：父母親教育程度別各組樣本自然科基測成績落於較差（≦25百分位）或較優（＞75百分位）之勝算比及其95﹪信賴區間 95 表18：父母親教育程度別各組樣本總分科基測成績落於較差（≦25百分位）或較優（＞75百分位）之勝算比及其95﹪信賴區間 96 表19：SGA，LGA與AGA樣本於2001~2005年基測成績落於較差（≦25百分位）或較優（＞75百分位）之勝算比及其95﹪信賴區間 97 表20：研究各組樣本分層分析基測總分成績落於較差（≦25百分位）或較優（＞ 75百分位）之勝算比及其95﹪信賴區間 99 表21：有無成功追蹤分析研究樣本之基本特徵描述 100 圖目錄………………………………………………………………………………...102 圖1：1985-1990年出生世代成為研究樣本之選取流程 102 圖2：1985-1986年出生世代成為研究樣本之選取流程 103 圖3：1986-1987年出生世代成為研究樣本之選取流程 104 圖4：1987-1988年出生世代成為研究樣本之選取流程 105 圖5：1988-1989年出生世代成為研究樣本之選取流程 106 圖6：1989-1990年出生世代成為研究樣本之選取流程 107 圖7暴露組嬰兒國文基測成績落於較優（＞第75百分位數）或較差（≦25第百分位數）之父母教育程度別勝算比 108 圖8暴露組嬰兒英語基測成績落於較優（＞第75百分位數）或較差（≦25第百分位數）之父母教育程度別勝算比 109 圖9暴露組嬰兒數學基測成績落於較優（＞第75百分位數）或較差（≦25第百分位數）之父母教育程度別勝算比 110 圖10暴露組嬰兒社會基測成績落於較優（＞第75百分位數）或較差（≦25第百分位數）之父母教育程度別勝算比 111 圖11暴露組嬰兒自然基測成績落於較優（＞第75百分位數）或較差（≦25第百分位數）之父母教育程度別勝算比 112 圖12暴露組嬰兒總分基測成績落於較優（＞第75百分位數）或較差（≦第25 百分位數）之父母教育程度別勝算比 113 附錄目錄 ………………………………………………………………….…………114 附錄1：1978-1997年出生登記不合理資料之判定原則與不合理紀錄數 114 附錄2：………………………………………………………………………….…115 研究樣本於2001年各科基測成績之四分位數分佈 115 研究樣本於2002年各科基測成績之四分位數分佈 117 研究樣本於2003年各科基測成績之四分位數分佈 119 研究樣本於2004年各科基測成績之四分位數分佈 121 研究樣本於2005年各科基測成績之四分位數分佈 123 附錄3： 125 研究樣本於2001年各科基測成績之平均值與標準差 125 研究樣本於2002年各科基測成績之平均值與標準差 126 研究樣本於2003年度各科基測成績之平均值與標準差 127 研究樣本於2004年各科基測成績之平均值與標準差 128 研究樣本於2005年各科基測成績之平均值與標準差 129
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