隨著醫療技術的進步，早產兒存活率逐漸提高，然而發生後遺症的機率並沒有下降。其中，以出生體重越低者風險越大。目前許多研究指出早產兒在幼兒期即顯現出執行功能方面之缺損，且此缺損會影響未來發展。但過去研究將執行功能與早期發展遲緩混淆討論，無法釐清為單純執行功能缺損或是早期發展遲緩影響所致，此混淆將會影響後續介入方向和療效。且目前在臨床上仍缺乏評估早期執行功能的工具，亦少有研究以早期功能發展作為預測未來執行功能的指標，故本研究目的在於探討無發展遲緩之極低出生體重早產兒在學齡前之執行功能，並嘗試透過回溯極低出生體重早產兒長期追蹤之早期功能發展表現，找出可預測學齡前執行功能之貝萊嬰幼兒發展量表第二版 (BSIDⅡ) 題項，並且預估貝萊嬰幼兒發展量表第三版 (BayleyⅢ) 題項對執行功能的預測性。
本研究樣本來自「財團法人中華民國早產兒基金會」所推廣的“全國極低體重早產兒追蹤檢查計畫”裡台南區的6歲發展正常 (BSIDⅡ分數小於70分) 早產兒，共55名。對照組則以性別、智力、年齡、父母社經地位與家庭教育環境做為配對條件，納入24名足月之發展正常兒童。以廣泛性非語文注意力測驗、倫敦塔、威斯康辛卡片分類測驗、Knox方塊仿效測驗與魏氏兒童智力測驗第四版中文版之記憶廣度分測驗作為執行功能衡鑑工具。早期功能發展則以極低出生體重早產兒在矯正年齡為六個月、一歲、一歲半和兩歲這四個時間點的BSIDⅡ各題表現作為指標。
研究結果顯示早期發展正常之極低出生體重早產兒於學齡前的計畫能力、認知彈性與非語文工作記憶三方面之表現顯著低於對照組，抑制能力和語文工作記憶則無顯著差異。此結果與過去研究部分相符，意味著即使幼時發展正常之極低出生體重早產兒，在未來仍是執行功能缺損的高風險群，相當值得關切。且當將懷孕週數和出生體重此二變項進行控制後，早產組執行功能表現僅有認知彈性達顯著差異，顯示“早產”的確對學齡前執行功能有所影響。早產兒早期發展功能與執行功能的部分，矯正年齡六個月之BSIDⅡ題項無法有效預測任一執行功能層面；矯正年齡一歲之部分BSIDⅡ題項可預測計畫能力；矯正年齡一歲半之部分BSIDⅡ題項可預測抑制能力和計畫能力，且與注意力監控有關；矯正年齡兩歲之部分BSIDⅡ題項可預測工作記憶。認知彈性能力則無法從任一時期的BSIDⅡ題項進行預測。以BayleyⅢ預估學齡前執行功能之結果與BSIDⅡ題項類似。

Background: Many studies showed that children born very low birthweight (VLBW) are at high risk of executive function (EF) deficit, including impulse control, working memory and cognitive flexibility. However, they did not exclude the influence of abnormal early development on EF deficit. In the mean time, Bayley Scales of Infant Development, Second Edition (BSIDⅡ) and Bayley Scales of Infant and Toddler Development, Third Edition (BayleyⅢ) are the most commonly and widely used measure of early cognitive and motor development in preterm infants, but the relationship between the above-mentioned development with EF in preterm children remains unknown.
Aims: The first aim was to investigate if six-year-old VLBW children with normal early development still have EF deficit. The second aim was to assess the predictive validity of BSIDⅡ Mental Developmental Index (MDI) item and Psychomotor Developmental Index (PDI) item at 6, 12, 18 and 24 months for EF in these children. And discuss the fitness of BayleyⅢ item in predicting EF.
Methods: The research was conducted in two groups. The VLBW group included 55 children at aged 6, with more than 70 of BSIDⅡ before aged 2. The normal group included 24 term children aged 6 who were born healthy and developed normally, with comparable IQ and social economic status. Five instruments, including Comprehensive Non-verbal Attention Test Battery (CNAT), Tower of London (ToL), Wisconsin Card Sorting Test (WCST), Knox’s Cube Imitation Test (KCIT) and Digit Span Subtest of WISC-IV, were analyzed to evaluate four kinds of EF, including impulse control, planning, cognitive flexibility and working memory. BSIDⅡ and BayleyⅢ were used as developmental index.
Results: First, the EF of VLBW group was significantly lower in independent t-test on the scores of planning in ToL, cognitive flexibility in WCST and nonverbal working memory in KCIT. Yet, the inferiority in EF of VLBW group became less significant when ANCOVA analysis was used to adjust gestation age and birthweight. Second, some items of BSIDⅡ showed R square bigger than .3 in 12, 18 and 24 months when predicting inhibition, planning, and working memory using Multiple Regression Analysis.
Discussion: Six-year-old VLBW children even with normal early development are still at risk of deficits in “planning”, “cognitive flexibility” and “nonverbal working memory” while the preterm factors, both gestation age and birthweight, were important covariant factors. As to the predictive validity of BSIDⅡ, part of the items of BSIDⅡ in 12, 18 and 24 months were predictiable for three aspects of EF including inhibition, planning, and working memory in these VLBW children. Part of the items of BayleyⅢ were also predictiable for EF.

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