早期干预对早产儿认知发育的影响
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摘要
目的探讨早期干预对早、晚期早产儿认知发育的影响,建立早产儿随访管理体系,探索有效的早期干预技术,改善早产儿预后。方法收集2016年1月1日至6月30日在常州市妇幼保健院儿保科早产儿高危儿门诊就诊出生的早产儿95例进行追踪随访,其中早期早产儿55例,晚期早产儿40例。所有研究对象于纠正胎龄满40周时进行新生儿行为神经评估(NBNA),早期早产儿作为实验组,根据NBNA评估结果,制定感知功能及运动功能的个体化早期干预方案,实行家庭-医院-家庭早期干预模式,晚期早产儿作为对照组进行常规被动操干预指导。所有研究对象于纠正胎龄6个月时应用Gesell发育量表进行发育评估。结果 95例早产儿的NBNA评估结果显示:早期早产儿的发育程度显著落后于晚期早产儿(χ~2=12.671,P=0.001)。通过一段时间的干预,早期早产儿在Gesell发育量表的"大运动行为"、"语言行为"及"个人社交行为"亚量表的评分显著优于晚期早产儿(t值分别为3.846、3.499、2.018,均P<0.05)。结论基于NBNA评估的早期干预可有效改善早产儿预后,但是晚期早产儿也必须给予足够重视。
Objective To investigate the influence of early intervention on the cognitive development of early and late preterm infants so as to establish a preterm follow-up management network for exploring effective early intervention and improving infants' prognosis. Methods Ninety-five cases of preterm infants born in the period of January 1 to June 30 in 2016 were followed up, including 55 early preterm infants and 40 late preterm infants. All subjects were assessed by neonatal behavioral neurological assessment(NBNA) when their corrected gestational ages were 40 weeks. According to the assessment results, individualized early intervention program including perceptive function and motor function was formulated for early preterm infants to realize a family-hospital-family early intervention model. And late preterm infants who acted as controls conducted routine passive exercises intervention. Eventually, all infants were assessed by Gesell developmental schedules when their corrected gestational ages were 6 months. Results According to the NBNA assessment of 95 preterm infants, the development of late preterm infants was better developed than that of early preterm infants(χ~2=12.671, P=0.001). When assessed by Gesell, the developmental quotient of gross motor, language and individuality in late preterm infants was significantly lower than that of early preterm infants(t value was 3.846, 3.499 and 2.018, respectively, all P<0.05). Conclusion The prognosis of preterm infants can be improved by early intervention based on the results of NBNA. Besides, late preterm infants must be given enough attention.
Objective To investigate the influence of early intervention on the cognitive development of early and late preterm infants so as to establish a preterm follow-up management network for exploring effective early intervention and improving infants' prognosis. Methods Ninety-five cases of preterm infants born in the period of January 1 to June 30 in 2016 were followed up, including 55 early preterm infants and 40 late preterm infants. All subjects were assessed by neonatal behavioral neurological assessment(NBNA) when their corrected gestational ages were 40 weeks. According to the assessment results, individualized early intervention program including perceptive function and motor function was formulated for early preterm infants to realize a family-hospital-family early intervention model. And late preterm infants who acted as controls conducted routine passive exercises intervention. Eventually, all infants were assessed by Gesell developmental schedules when their corrected gestational ages were 6 months. Results According to the NBNA assessment of 95 preterm infants, the development of late preterm infants was better developed than that of early preterm infants(χ~2=12.671, P=0.001). When assessed by Gesell, the developmental quotient of gross motor, language and individuality in late preterm infants was significantly lower than that of early preterm infants(t value was 3.846, 3.499 and 2.018, respectively, all P<0.05). Conclusion The prognosis of preterm infants can be improved by early intervention based on the results of NBNA. Besides, late preterm infants must be given enough attention.
引文
[1]Allotey J, Zamora J, Cheong-See F, et al. Cognitive, motor, behavioural and academic performances of children born preterm:a meta-analysis and systematic review involving 64 061 children[J]. BJOG: An International Journal of Obstetrics & Gynaecology, 2018, 125(1): 16-25.
[2] 张冬梅. 早产儿脑病研究进展[J]. 国际儿科学杂志, 2012 (2): 173-176.
[3]Spittle A, Orton J, Anderson P, et al. Early developmental intervention programmes post-hospital discharge to prevent motor and cognitive impairments in preterm infants[J]. Cochrane Database of Systematic Reviews, 2012,12:CD005495.
[4] 熊家玲, 刘宇, 喻琴. 早期综合干预对早产儿生长发育的影响[J]. 中国妇幼健康研究, 2016, 27(9):1035-1037.
[5]王爱平, 丁春艳, 郑莉莉, 等. 92例早产儿早期干预的效果分析[J]. 中国妇幼健康研究, 2015,26(3):474-476.
[6]Stoll B J, Hansen N I, Bell E F, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012[J].Jama, 2015, 314(10): 1039-1051.
[7]Heron M, Sutton P D, Xu J Q, et al. Annual summary of vital statistics: 2007.[J]. Pediatrics, 2010, 125(1):4-15.
[8]Hamilton B E, Martin J A, Osterman M J, et al. Births: Final Data for 2014[J]. Natl Vital Stat Rep, 2015, 64(12):1.
[9]Hack M. Adult outcomes of preterm children[J]. Journal of Developmental & Behavioral Pediatrics, 2009, 30(5): 460-470.
[10]Tran L, Huening B M, Kaiser O, et al. Cerebellar-dependent associative learning is impaired in very preterm born children and young adults[J]. Scientific Reports, 2017, 7(1): 18028.
[11] 张腾伟, 林法涛, 宋燕燕, 等. 晚期早产儿早期智能发育结局的研究[J]. 中国当代儿科杂志, 2017, 19(2): 142-146.
[12]王清清, 苏卫东, 黄育丹,等. 晚期早产儿早期智能发育及其影响因素研究[J]. 中国新生儿科杂志, 2016, 31(1):9-13.
[13]Engle W A. A recommendation for the definition of “late preterm” (near-term) and the birth weight-gestational age classification system[J]. Seminars in Perinatology, 2006, 30(1):2-7.
[2] 张冬梅. 早产儿脑病研究进展[J]. 国际儿科学杂志, 2012 (2): 173-176.
[3]Spittle A, Orton J, Anderson P, et al. Early developmental intervention programmes post-hospital discharge to prevent motor and cognitive impairments in preterm infants[J]. Cochrane Database of Systematic Reviews, 2012,12:CD005495.
[4] 熊家玲, 刘宇, 喻琴. 早期综合干预对早产儿生长发育的影响[J]. 中国妇幼健康研究, 2016, 27(9):1035-1037.
[5]王爱平, 丁春艳, 郑莉莉, 等. 92例早产儿早期干预的效果分析[J]. 中国妇幼健康研究, 2015,26(3):474-476.
[6]Stoll B J, Hansen N I, Bell E F, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012[J].Jama, 2015, 314(10): 1039-1051.
[7]Heron M, Sutton P D, Xu J Q, et al. Annual summary of vital statistics: 2007.[J]. Pediatrics, 2010, 125(1):4-15.
[8]Hamilton B E, Martin J A, Osterman M J, et al. Births: Final Data for 2014[J]. Natl Vital Stat Rep, 2015, 64(12):1.
[9]Hack M. Adult outcomes of preterm children[J]. Journal of Developmental & Behavioral Pediatrics, 2009, 30(5): 460-470.
[10]Tran L, Huening B M, Kaiser O, et al. Cerebellar-dependent associative learning is impaired in very preterm born children and young adults[J]. Scientific Reports, 2017, 7(1): 18028.
[11] 张腾伟, 林法涛, 宋燕燕, 等. 晚期早产儿早期智能发育结局的研究[J]. 中国当代儿科杂志, 2017, 19(2): 142-146.
[12]王清清, 苏卫东, 黄育丹,等. 晚期早产儿早期智能发育及其影响因素研究[J]. 中国新生儿科杂志, 2016, 31(1):9-13.
[13]Engle W A. A recommendation for the definition of “late preterm” (near-term) and the birth weight-gestational age classification system[J]. Seminars in Perinatology, 2006, 30(1):2-7.