昆明市6～36月龄婴幼儿神经心理发育现状及其影响因素研究
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摘要
目的研究昆明市6～36月龄婴幼儿神经心理发育的现状及其影响因素,为促进儿童神经心理发育提供依据。方法采集2016年8月-2017年7月在延安医院预防保健科门诊随诊的310名6～36月龄婴幼儿基本资料,收集其出生/患病情况、母亲孕期情况、家庭情况及主要照顾者等相关信息。用"0～6岁儿童发育筛查测验"(DST)进行发育评估,测量儿童身长、体重及头围,并应用年龄别身长、年龄别体重、年龄别头围等指标对其进行生长发育状况评价。用有序多分类Logistic回归分析影响婴幼儿发育商(DQ)和智力指数(MI)的因素。结果 310名儿童中DQ≥85分占51.0%,70～84分占40.3%,<70分占8.7%;MI≥85分占75.2%,70～84分占18.7%,<70分占6.1%;其中运动智龄落后于实际年龄的占61.3%。Logistic回归分析显示,男性(OR=0.453,95%CI:0.245～0.839),低出生体重(OR=0.150,95%CI:0.019～0.968)、高龄分娩(OR=0.216,95%CI:0.055～0.852)、无兄弟姐妹(OR=0.459,95%CI:0.237～0.887)是DQ低于正常的危险因素;母亲家务及待业(OR=2.487,95%CI:1.247～4.963)是DQ低于正常的保护因素。结论儿童神经心理发育水平有待提高,应关注其影响因素,促进婴幼儿神经心理发育。
Objective To explore the current situation and related influencing factors of neuropsychological development among 6 to 36-month-old infants in Kunming,in order to provide reference for facilitating neurodevelopment of children. Methods A total of 310 infants aged 6-36 months were selected as participants in the department of preventive healthcare,Yan′an Hospital Affiliated to Kunming Medical University from August 2016 to July 2017. Data on history of delivery/disease,pregnancy complications,family status and main caregiver were collected through questionnaire survey. Developmental Screening Test for children under six(DST) was used to conduct neuropsychological test among these infants. The weight-for-age,length-for-age,head circumference-for-age were used to evaluate physical development. Multi-factor ordinal logistic regression analysis was used to screen the influencing factors for neuropsychological development among infants. Results The rates of "normal(DQ≥85)", "suspicious(70≤DQ≤84)", "abnormal(DQ<70)" on development quotient(DQ) in 310 infants were 51.0%,40.3% and 8.7%,respectively,while 75.2%,18.7% and 6.1% on MI(mental index). And 61.3% of infants had gross motor delays. Multi-factor ordinal Logistic regression analysis showed those DQ delays were significantly associated with gender(OR=0.453,95%CI:0.245-0.839),low birth weight(OR=0.150,95%CI:0.019-0.968),elderly childbirth(OR=0.216,95%CI:0.055-0.852),without siblings(OR=0.459,95%CI:0.237-0.887).Maternal unemployed(OR=2.487,95%CI:1.247-4.963) were protective factor to DQ delay. Conclusion It is suggested to pay more attention to influencing factors and take measures to improve the neuropsychological development of infants.
Objective To explore the current situation and related influencing factors of neuropsychological development among 6 to 36-month-old infants in Kunming,in order to provide reference for facilitating neurodevelopment of children. Methods A total of 310 infants aged 6-36 months were selected as participants in the department of preventive healthcare,Yan′an Hospital Affiliated to Kunming Medical University from August 2016 to July 2017. Data on history of delivery/disease,pregnancy complications,family status and main caregiver were collected through questionnaire survey. Developmental Screening Test for children under six(DST) was used to conduct neuropsychological test among these infants. The weight-for-age,length-for-age,head circumference-for-age were used to evaluate physical development. Multi-factor ordinal logistic regression analysis was used to screen the influencing factors for neuropsychological development among infants. Results The rates of "normal(DQ≥85)", "suspicious(70≤DQ≤84)", "abnormal(DQ<70)" on development quotient(DQ) in 310 infants were 51.0%,40.3% and 8.7%,respectively,while 75.2%,18.7% and 6.1% on MI(mental index). And 61.3% of infants had gross motor delays. Multi-factor ordinal Logistic regression analysis showed those DQ delays were significantly associated with gender(OR=0.453,95%CI:0.245-0.839),low birth weight(OR=0.150,95%CI:0.019-0.968),elderly childbirth(OR=0.216,95%CI:0.055-0.852),without siblings(OR=0.459,95%CI:0.237-0.887).Maternal unemployed(OR=2.487,95%CI:1.247-4.963) were protective factor to DQ delay. Conclusion It is suggested to pay more attention to influencing factors and take measures to improve the neuropsychological development of infants.
引文
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[12] Yueh MF.Developmental,genetic,dietary,and xenobiotic influences on neonatal hyperbilirubinemia[J]. Mol Pharmacol,2017,91(5):545-553.
[13] Chen LM,Chen QS,Jin GX,et al.Effect of gestational subclinical hypothyroidism on early neurodevelopment of offspring[J]. J Perinatol,2015,35(9):678-682.
[14] Ursache A,Noble KG.Socioeconomic status,white matter,and executive function in children[J]. Brain Behav,2016,6(10):e00531.
[15] Schonhaut L,Perez M,Munoz S.Association between neontal morbidity,gestational age and developmental delays in moderate to late preterm children[J]. Rev Chil Pediatr,2015,86(6):415-425.
[2] Casey BJ,Tottenham N,Liston C,et al. Imaging the developing brain:what have we learned about cognitive development?[J]. Trends Cogn Sci,2005,9:104-110.
[3] 郑慕时,冯玲英,刘湘云,等.0～6岁儿童智能发育筛查测验全国城市常模的制定[J].中华儿科杂志,1997,34(3):6-9.
[4] 范果叶,王文瑞,张海蓉,等.呼和浩特市1850例婴幼儿智能发育状况及影响因素分析[J].中国妇幼健康研究,2017,28(1):6-9.
[5] 熊淑英,黄旭丽.18月龄幼儿血清维生素D水平与神经发育的临床观察[J].中国儿童保健杂志,2018,26(3):332-334.
[6] Mous SE,Schoemaker NK, Blanken LME,et al.The association of gender,age,and intelligence with neuropsychological functioning in young typically developing children:The Generation R study [J]. Appl Neuropsychol Child,2017,6(1):22-40.
[7] Wang Y,Xu Q, Li S,et al.Gender differences in anomalous subcortical morphology for children with ADHD[J]. Neurosci Lett,2018,665:176-181.
[8] 胡瑞杰,马自芳,薛钟瑜,等.儿童性别与父母教养方式对神经行为的影响[J].中国学校卫生,2018,39(1):136-138.
[9] Andersson HW, Sommerfelt K.The relationship between cognitive abilities and maternal ratings of externalizing behaviors in preschool children[J]. Scand J Psychol,2001,42(5):437-444.
[10] Lizana JR,Roman P.Neuropsychological assessment and perinatal risk:A study amongst very premature born 4- and 5-year old children [J].Res Dev Disabil,2017,(69):116-123.
[11] 秦伟,冉霓,衣明纪,等.早产低出生体重婴幼儿智力和运动发育纵向随访研究[J].中国儿童保健杂志,2012,20(1):23-25,31.
[12] Yueh MF.Developmental,genetic,dietary,and xenobiotic influences on neonatal hyperbilirubinemia[J]. Mol Pharmacol,2017,91(5):545-553.
[13] Chen LM,Chen QS,Jin GX,et al.Effect of gestational subclinical hypothyroidism on early neurodevelopment of offspring[J]. J Perinatol,2015,35(9):678-682.
[14] Ursache A,Noble KG.Socioeconomic status,white matter,and executive function in children[J]. Brain Behav,2016,6(10):e00531.
[15] Schonhaut L,Perez M,Munoz S.Association between neontal morbidity,gestational age and developmental delays in moderate to late preterm children[J]. Rev Chil Pediatr,2015,86(6):415-425.
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