不同胎龄早产儿体格发育和神经心理发育研究
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摘要
目的比较1岁内不同胎龄早产儿体格发育和神经心理发育差异。方法江西省妇幼保健院出生146例早产儿,根据出生胎龄分为早期早产儿(胎龄<32周)和中晚期早产儿(胎龄≥32周),其中早期早产儿65例,中晚期早产儿81例;要求研究对象矫正月龄1～6、8、10及12月进行随访,生长发育评价使用Z值(Z score)评价,生长标准选用WHO 2006生长标准,对其0～12月内的体重、身长及头围分别进行Z值评估并分析,计算年龄的身长Z值(Z score of length for age LAZ)、年龄的体重Z值(Z score of weight for age WAZ)、身长的体重Z值(Z score of weight for length WLZ)和年龄的头围Z值(Z score of head circumference HCZ);分别于矫正6月龄和12月龄采用CDCC婴幼儿智能发育量表测试随访对象智力发育指数(mental development index,MDI)和运动发育指数(psychomotor development index,PDI)。结果两组早产儿男女构成比和出生体重差异均有统计学意义(P <0. 05);<32周早产儿矫正6月龄和12月龄LAZ低于≥32周早产儿;<32周早产儿矫正6月龄WAZ低于≥32周早产儿;<32周早产儿矫正6月龄WHZ低于≥32周早产儿,差异均有统计学意义(P <0. 05);两组早产儿HCZ各月龄段差异均无统计学意义(P> 0. 05);经矫正后得分,<32周早产儿6月龄和12月龄MDI低于≥32周早产儿,12月龄PDI亦低于后者。结论早期早产儿体格发育和神经心理状况落后于中晚期早产儿,应重视不同胎龄的早产儿保健。
Objective To investigate the physical growth and neurodevelopment status of the preterm infants of different gestation with the first year. Method A total of 146 preterm infants were divided into early preterm infants( less than 32 weeks) group( 65 cases) and moderate and late preterm infants( more than or equal to 32 weeks) group( 81 cases),and followed up regularly. The preterm infants were follow up at the following correction months: 1,2,3,4,5,6,8,10 and 12. The physical growth levels of children were evaluated by WHO 2006 standard. Z scores of length for age( LAZ),weight for age( WAZ),weight for length( WLZ)and head circumference( HCZ) of the preterm infants were calculated. CDCC infant development scale was used to evaluate their neurodevelopment at age 6 and 12 correction months,the results was indicated as mental development index( MDI) and psychomotor development index( PDI). Results The sexual ratio and birth weight had significant difference between the two groups( P < 0. 05).The LAZ at 6 and 12 correction months in early preterm infants were less than the moderate and late preterm infants. The WAZ at 6 correction months in early preterm infants were less than the moderate and late preterm infants. The WLZ at 6 correction months in early preterm infants were less than the moderate and late preterm infants. The differences were statistically significant( P < 0. 05). The HCZ of the two groups has no statistical difference( P > 0. 05). Conclusions The physical growth and neurodevelopment of the early preterm infants are worse than the moderate and late preterm infants. Therefore,preterm infants of different gestation have different trend of physical growth and neurodevelopment. Attention should be paid to the health care of premature infants of different gestational age.
Objective To investigate the physical growth and neurodevelopment status of the preterm infants of different gestation with the first year. Method A total of 146 preterm infants were divided into early preterm infants( less than 32 weeks) group( 65 cases) and moderate and late preterm infants( more than or equal to 32 weeks) group( 81 cases),and followed up regularly. The preterm infants were follow up at the following correction months: 1,2,3,4,5,6,8,10 and 12. The physical growth levels of children were evaluated by WHO 2006 standard. Z scores of length for age( LAZ),weight for age( WAZ),weight for length( WLZ)and head circumference( HCZ) of the preterm infants were calculated. CDCC infant development scale was used to evaluate their neurodevelopment at age 6 and 12 correction months,the results was indicated as mental development index( MDI) and psychomotor development index( PDI). Results The sexual ratio and birth weight had significant difference between the two groups( P < 0. 05).The LAZ at 6 and 12 correction months in early preterm infants were less than the moderate and late preterm infants. The WAZ at 6 correction months in early preterm infants were less than the moderate and late preterm infants. The WLZ at 6 correction months in early preterm infants were less than the moderate and late preterm infants. The differences were statistically significant( P < 0. 05). The HCZ of the two groups has no statistical difference( P > 0. 05). Conclusions The physical growth and neurodevelopment of the early preterm infants are worse than the moderate and late preterm infants. Therefore,preterm infants of different gestation have different trend of physical growth and neurodevelopment. Attention should be paid to the health care of premature infants of different gestational age.
引文
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[7]《中华儿科杂志》编辑委员会.早产、低出生体重儿出院后喂养建议[J].中华儿科杂志,2016,54(1):6-12.
[8] Brandt I, Sticker E, Gausche M, et al. Catch-up growth of supine length/height of very low birth weight,small for gestational age preterm infants to adulthood[J]. J Pediatr,2005,147(5):662-668.
[9] Linsell L,Johnson S,Wolke D,et al. Cognitive trajectories from infancy to early adulthood following birth before26 weeks of gestation:a prospective,population-based cohort study[J]. Arch Dis Child,2018,103(4):363-370.
[10]余章斌,韩树萍,邱玉芳,等.系统评价早产对儿童智力发育的影响及早期干预作用[J].中国循证儿科杂志,2012,7(2):113-119.
[11] Richards JL,Drews-Botsch C,Sales JM,et al. Describing the shape of the relationship between gestational age at birth and cognitive development in a national representative U. S birth cohort[J]. Paediatr Perinat Epidemiol[J]. 2016,30(6):571-582.
[2] Van Dommelen P, Van der Pal SM, Bennebroek Gravenhorst J,et al. The effect of early catch-up growth on health and well-being in young adults[J]. Ann Nutr Metab,2014,65(2-3):220-6.
[3] Sicard M,Nusinovici S,Hanf M,et al. Fetal and Postnatal Head Circumference Growth:Synergetic Factors for Neurodevelopmental Outcome at 2 Years of Age for Preterm Infants[J]. Neonatology,2017,112(2):122-129.
[4] Ferguson EC,Wright NP,Gibson AT,et al. Adult height of preterm infants:a longitudinal cohort study[J]. Arch Dis Child,2017,102(6):503-508.
[5] Kerkhof GF,Willemsen RH,Leunissen RW,et al.Health profile of young adults born preterm:negative effects of rapid weight gain in early life[J]. J Clin Endocrinol Metab,2012,97(12):4498-4506.
[6] Embleton ND,Korada M,Wood CL,et al. Catch-up growth and metabolic outcomes in adolescents born preterm[J]. Arch Dis Child,2016,101(11):1026-1031.
[7]《中华儿科杂志》编辑委员会.早产、低出生体重儿出院后喂养建议[J].中华儿科杂志,2016,54(1):6-12.
[8] Brandt I, Sticker E, Gausche M, et al. Catch-up growth of supine length/height of very low birth weight,small for gestational age preterm infants to adulthood[J]. J Pediatr,2005,147(5):662-668.
[9] Linsell L,Johnson S,Wolke D,et al. Cognitive trajectories from infancy to early adulthood following birth before26 weeks of gestation:a prospective,population-based cohort study[J]. Arch Dis Child,2018,103(4):363-370.
[10]余章斌,韩树萍,邱玉芳,等.系统评价早产对儿童智力发育的影响及早期干预作用[J].中国循证儿科杂志,2012,7(2):113-119.
[11] Richards JL,Drews-Botsch C,Sales JM,et al. Describing the shape of the relationship between gestational age at birth and cognitive development in a national representative U. S birth cohort[J]. Paediatr Perinat Epidemiol[J]. 2016,30(6):571-582.