晚期早产儿早期神经系统发育情况及其影响因素
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摘要
目的探讨晚期早产儿早期神经系统发育情况及其影响因素。方法选取广东省妇幼保健院产科2015年6月至2016年5月出生的150例晚期早产儿为研究对象(晚期组),通过多种因素配对后,选取同期150例足月儿作为对照(足月组)。于晚期早产儿矫正胎龄40周、6个月龄以及1周岁时三个时间点对两组儿童进行智能测试,比较晚期组和足月组智能发育水平。根据上述智能测试结果将晚期组分为发育正常组和发育异常组,分析影响神经系统发育的危险因素。结果晚期组和足月组在矫正胎龄40周、6个月龄和1周岁纳入随访者分别为150例、142例、135例和150例、127例、115例;6个月龄晚期组早产儿大运动明显落后于足月儿,1周岁时大运动、精细运动和语言均落后于足月儿,差异均有统计学意义(P<0.05);多因素分析结果显示,小于胎龄、低血糖、Apgar评分、败血症、新生儿呼吸窘迫综合征和父母文化程度低是影响晚期早产儿早期发育的危险因素(P<0.05)。结论晚期早产儿早期神经系统发育落后于足月儿,小于胎龄、新生儿呼吸窘迫综合征、低血糖、Apgar评分、败血症和父母文化程度低是影响晚期早产儿早期神经系统发育的危险因素。
Objective To explore the early development of nervous system in late preterm infants and its influencing factors. Methods A total of 150 late preterm infants born in the Department of Obstetrics, Guangdong Maternal and Child Health Hospital from June 2015 to May 2016 were selected as subjects(late group), and, after pairing with various factors, 150 full-term children were selected as controls(full-term group). Intelligent tests were performed in the two groups at 40 weeks, 6 months and 1 year of corrected age, and the intelligence development levels of the late group and the full-term group was compared. According to the above intelligent test results, the late group were further divided into the normal development group and the dysplastic group, and the risk factors affecting the development of the nervous system were analyzed. Results A total of 150, 142, 135 late preterm infants were assessed at 40 weeks, 6 months and 1 year of corrected age, respectively. Meanwhile, 150, 127 and 115 full-term infants were also evaluated in the corresponding time. At corrected age of 6 months, the development of gross motor skills in the late group were lagging behind their peers of full-term birth; at corrected age of 1 year, the development of gross motor skills, fine motor skills, and language skills in late preterm infants remain lagging behind full-term infants, and the differences were both statistically significant(P<0.05). Multivariate analysis showed that less than gestational age, hypoglycemia, Apgar score, sepsis, neonatal respiratory distress syndrome, and low parental education were risk factors for early development of the nervous system in late preterm infants(P<0.05). Conclusion In the early stage of late preterm infants, the development of the nervous system lags behind full-term children. Less than gestational age, neonatal respiratory distress syndrome, hypoglycemia, Apgar score, sepsis, and low parental education are risk factors for the development of early advanced nervous system in late preterm infants.
Objective To explore the early development of nervous system in late preterm infants and its influencing factors. Methods A total of 150 late preterm infants born in the Department of Obstetrics, Guangdong Maternal and Child Health Hospital from June 2015 to May 2016 were selected as subjects(late group), and, after pairing with various factors, 150 full-term children were selected as controls(full-term group). Intelligent tests were performed in the two groups at 40 weeks, 6 months and 1 year of corrected age, and the intelligence development levels of the late group and the full-term group was compared. According to the above intelligent test results, the late group were further divided into the normal development group and the dysplastic group, and the risk factors affecting the development of the nervous system were analyzed. Results A total of 150, 142, 135 late preterm infants were assessed at 40 weeks, 6 months and 1 year of corrected age, respectively. Meanwhile, 150, 127 and 115 full-term infants were also evaluated in the corresponding time. At corrected age of 6 months, the development of gross motor skills in the late group were lagging behind their peers of full-term birth; at corrected age of 1 year, the development of gross motor skills, fine motor skills, and language skills in late preterm infants remain lagging behind full-term infants, and the differences were both statistically significant(P<0.05). Multivariate analysis showed that less than gestational age, hypoglycemia, Apgar score, sepsis, neonatal respiratory distress syndrome, and low parental education were risk factors for early development of the nervous system in late preterm infants(P<0.05). Conclusion In the early stage of late preterm infants, the development of the nervous system lags behind full-term children. Less than gestational age, neonatal respiratory distress syndrome, hypoglycemia, Apgar score, sepsis, and low parental education are risk factors for the development of early advanced nervous system in late preterm infants.
引文
[1]甘斌,魏贤,何源,等.晚期早产儿生后早期神经发育的评估研究[J].中国优生与遗传杂志, 2017, 25(6):82-84.
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[9]殷张华,钱继红,王蓓,等.晚期早产儿近期并发症及智能发育前瞻性研究[J].中国新生儿科杂志, 2015, 30(2):112-116.
[10]苗丹童,张冰,朱斌.弥散张量成像在胎儿脑发育中的研究进展[J].磁共振成像, 2017, 8(2):149-154.
[11]孙殿荣,侯梅,郭洪磊.婴幼儿脑瘫治疗前后Gesell发育量表的评估结果及分析[J].中国儿童保健杂志, 2015, 23(1):67-69.
[12]王晓琴,王莹,李红.早产儿脑损伤的危险因素[J].中国新生儿科杂志, 2015, 30(4):286-288.
[2]王艳娟,卢云,吴晓庆,等.新生儿神经行为测定在早产儿神经心理发育中的作用[J].中国妇幼保健, 2013, 28(1):71-73.
[3]叶平,李艳,赵莹莹,等.早产儿局灶性脑白质损伤的多因素分析[J].临床放射学杂志, 2019, 38(1):156-160.
[4]鲁利群,屈艺,母得志.晚期早产儿出生18月龄神经发育情况[J].中华实用儿科临床杂志, 2015, 30(5):379.
[5]邢珊,刘俐,李改莲,等. NBNA评分在评价早产儿脑发育,脑损伤及预后中的应用[J].中国儿童保健杂志, 2016, 24(2):191-194.
[6]邢珊,孙慧清. NBNA评分与TMS评分在评价早产儿脑发育及脑损伤中的作用及相关性分析[J].河南医学研究, 2018, 27(8):1393-1394.
[7]孙国玉,侯新琳,周丛乐,等.早产儿生后早期振幅整合脑电图特点及其影响因素[J].中华围产医学杂志, 2015, 18(4):268-274.
[8]黎江,薄涛,陈铁强,等. 181例早产儿神经行为发育的回顾性研究[J].中国当代儿科杂志, 2014, 16(7):696-700.
[9]殷张华,钱继红,王蓓,等.晚期早产儿近期并发症及智能发育前瞻性研究[J].中国新生儿科杂志, 2015, 30(2):112-116.
[10]苗丹童,张冰,朱斌.弥散张量成像在胎儿脑发育中的研究进展[J].磁共振成像, 2017, 8(2):149-154.
[11]孙殿荣,侯梅,郭洪磊.婴幼儿脑瘫治疗前后Gesell发育量表的评估结果及分析[J].中国儿童保健杂志, 2015, 23(1):67-69.
[12]王晓琴,王莹,李红.早产儿脑损伤的危险因素[J].中国新生儿科杂志, 2015, 30(4):286-288.