上海市高危儿神经发育情况及其影响因素分析
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摘要
目的了解高危儿的神经发育现状,分析其神经发育的影响因素,为孕期教育和完善高危儿的诊疗提供理论依据。方法 2016年3月-2017年10月采用整群抽样的方法,将上海市3家妇幼保健院进行保健体检的603名高危儿及其照顾者作为研究对象,采用自行设计的问卷调查和Gesell发育诊断检查,每个能区测试结果以发育商表示。运用Logistics回归分析其神经心理发育的影响因素。结果本次研究共调查603名高危儿,年龄平均为(6.69±3.53)月,其中男童305名(50.6%),女童298名(49.4%),动作能、应物能、言语能和应人能的异常率分别为10.0%、14.9%、12.1%和8.5%。Logistics回归分析发现,在控制混杂因素后,早产、低出生体重儿、新生儿肺炎、母亲怀孕期间偶尔饮酒、母亲孕期情绪紧张是动作能发育异常的危险因素;低出生体重儿、母亲怀孕期间偶尔饮酒是应物能发育异常的危险因素;早产、母亲怀孕期间偶尔饮酒、父亲情绪紧张是言语能发育异常的危险因素;早产、母亲怀孕期间偶尔饮酒是应人能发育异常的危险因素。结论早产和低出生体重儿的脑功能发育需要加强关注,孕期饮酒和孕期父母的情绪对高危儿神经心理发育影响不可忽视。
Objective To investigate the current status and influencing factors for neurodevelopment of high-risk infants,in order to provide implications for pregnancy education and improving the diagnosis and treatment of high-risk infants. Methods A cross-sectional survey with cluster sampling was adopted from March 2016 to October 2017. Totally 603 high-risk infants and caregivers from three Maternal and Child Health(MCH) hospitals in Shanghai were selected as participants,questionnaire surveys and Gesell Development Diagnostic Tests were carried out. Logistic regression was used to analyze the influencing factors of neuropsychological development. Results A total of 603 high-risk infants were investigated in this study,with an average age of(6.69±3.53) months,of which 305(50.6%) were boys and 298(49.4%) were girls. The abnormal rates of motor development,cognition development,language development and person-skills development were 10.0%,14.9%,12.1%,and 8.5%,respectively. Logistic regression analysis showed that premature birth,low birth weight infants,neonatal pneumonia,occasional alcohol intake during pregnancy and maternal emotional stress during pregnancy were risk factors for motor development. Low birth weight infants,occasional alcohol intake during pregnancy were risk factors for cognition development. Premature birth,occasional alcohol intake during pregnancy and father′s emotional stress were risk factors for language development. Premature birth and occasional alcohol intake during mother′s pregnancy were risk factors for person-skills development. Conclusions Preterm infants and low birth weight infants should be given more concern on their neurodevelopment. Occasional alcohol and parents′ emotional stress have negative effect on neurodevelopment.
Objective To investigate the current status and influencing factors for neurodevelopment of high-risk infants,in order to provide implications for pregnancy education and improving the diagnosis and treatment of high-risk infants. Methods A cross-sectional survey with cluster sampling was adopted from March 2016 to October 2017. Totally 603 high-risk infants and caregivers from three Maternal and Child Health(MCH) hospitals in Shanghai were selected as participants,questionnaire surveys and Gesell Development Diagnostic Tests were carried out. Logistic regression was used to analyze the influencing factors of neuropsychological development. Results A total of 603 high-risk infants were investigated in this study,with an average age of(6.69±3.53) months,of which 305(50.6%) were boys and 298(49.4%) were girls. The abnormal rates of motor development,cognition development,language development and person-skills development were 10.0%,14.9%,12.1%,and 8.5%,respectively. Logistic regression analysis showed that premature birth,low birth weight infants,neonatal pneumonia,occasional alcohol intake during pregnancy and maternal emotional stress during pregnancy were risk factors for motor development. Low birth weight infants,occasional alcohol intake during pregnancy were risk factors for cognition development. Premature birth,occasional alcohol intake during pregnancy and father′s emotional stress were risk factors for language development. Premature birth and occasional alcohol intake during mother′s pregnancy were risk factors for person-skills development. Conclusions Preterm infants and low birth weight infants should be given more concern on their neurodevelopment. Occasional alcohol and parents′ emotional stress have negative effect on neurodevelopment.
引文
[1] Chawla S,Natarajan G,Shankaran S,et al. Association of neurodevelopmental outcomes and neonatal morbidities of extremely premature infants with differential exposure to antenatal steroids[J]. Jama Pediatr,2016,170(12):1164-1172.
[2] 解雅春,姚天红,胡小沙,等.儿童早期发展训练对婴儿神经心理发育影响的分析[J].中国儿童保健杂志,2013,21(11):1228-1230.
[3] 朱庆庆,宋嫒,王桂荣,等.早期教育对婴幼儿身心健康影响的研究[J].中国妇幼保健,2011,26(12):1777-1779.
[4] 杨玉凤.不良环境因素对脑发育及智能的影响[J].中国儿童保健杂志,2004,12(1):55-57.
[5] Filgueiras A,Pires P,Maissonette S,et al. Psychometric properties of the Brazilian-adapted version of the Ages and Stages Questionnaire in public child daycare centers[J]. Early Hum Dev,2013,89(8):561-576.
[6] 徐姗姗.婴幼儿诊断性发育量表研究及应用进展[J].中国儿童保健杂志,2010,18(11):859-861.
[7] 石惠卿,王红兵,陈津津. 上海市静安区12月龄婴儿丹佛发育筛查及其智能发育相关因素分析[J]. 上海交通大学学报:医学版,2017,37(9):1206-1211.
[8] 许琪,李瑞莉,金春华,等.北京市0～3岁儿童神经心理发育现状及影响因素分析[J].中国妇幼保健,2015,30(20):3404-3406.
[9] Johnson S,Wolke D,Hennessy E,et al. Educational outcomes in extremely preterm children:neuropsychological correlates and predictors of attainment[J]. Dev Neuropsychol,2011,36(1):74-95.
[10] Platt MJ,Cans C,Johnson A,et al. Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres:a database study[J]. Lancet,2007,369(9555):43-50.
[11] 李蓓,冯菁菁,徐秀. 早产儿早期神经运动发育纵向随访[J]. 中国儿童保健杂志,2013,21(5):470-472.
[12] Biosca M,Rodríguez G,Ventura P,et al. Central adiposity in children born small and large for gestational age[J]. Nutr Hosp,2011,26(5):971-976.
[13] 高鸿,赵杉,王亚莉,等. 母孕期饮酒行为现状及对其子女认知行为影响的初步调查[J]. 中国儿童保健杂志,2011,19(5):423-425.
[2] 解雅春,姚天红,胡小沙,等.儿童早期发展训练对婴儿神经心理发育影响的分析[J].中国儿童保健杂志,2013,21(11):1228-1230.
[3] 朱庆庆,宋嫒,王桂荣,等.早期教育对婴幼儿身心健康影响的研究[J].中国妇幼保健,2011,26(12):1777-1779.
[4] 杨玉凤.不良环境因素对脑发育及智能的影响[J].中国儿童保健杂志,2004,12(1):55-57.
[5] Filgueiras A,Pires P,Maissonette S,et al. Psychometric properties of the Brazilian-adapted version of the Ages and Stages Questionnaire in public child daycare centers[J]. Early Hum Dev,2013,89(8):561-576.
[6] 徐姗姗.婴幼儿诊断性发育量表研究及应用进展[J].中国儿童保健杂志,2010,18(11):859-861.
[7] 石惠卿,王红兵,陈津津. 上海市静安区12月龄婴儿丹佛发育筛查及其智能发育相关因素分析[J]. 上海交通大学学报:医学版,2017,37(9):1206-1211.
[8] 许琪,李瑞莉,金春华,等.北京市0～3岁儿童神经心理发育现状及影响因素分析[J].中国妇幼保健,2015,30(20):3404-3406.
[9] Johnson S,Wolke D,Hennessy E,et al. Educational outcomes in extremely preterm children:neuropsychological correlates and predictors of attainment[J]. Dev Neuropsychol,2011,36(1):74-95.
[10] Platt MJ,Cans C,Johnson A,et al. Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres:a database study[J]. Lancet,2007,369(9555):43-50.
[11] 李蓓,冯菁菁,徐秀. 早产儿早期神经运动发育纵向随访[J]. 中国儿童保健杂志,2013,21(5):470-472.
[12] Biosca M,Rodríguez G,Ventura P,et al. Central adiposity in children born small and large for gestational age[J]. Nutr Hosp,2011,26(5):971-976.
[13] 高鸿,赵杉,王亚莉,等. 母孕期饮酒行为现状及对其子女认知行为影响的初步调查[J]. 中国儿童保健杂志,2011,19(5):423-425.