目的 探讨极低出生体重儿(very low birth weight infant, VLBWI)和超低出生体重儿(extremely birth weight infant, ELBWI)不同时期神经发育损害发生的变化趋势。方法 复旦大学附属儿科医院新生儿科2005年10月1日-2010年12月31日收治并救治成活的VLBWI和ELBWI, 纠正胎龄18～42个月, 完成贝莉婴儿发育量表-Ⅱ(Bayley Scales of Infant Development-Ⅱ, BSID-Ⅱ)的患儿有143例, 按入院时间分为两个阶段, 第一阶段为2005年10月1日-2008年12月31日入院的患儿, 共54例;第二阶段为2009年1月1日-2010年12月31日入院的患儿, 共89例。比较两个阶段患儿的神经发育预后情况。结果 两个阶段的研究对象在性别、胎龄、出生体重及分布上均相似。第一阶段患儿的智力发育指数得分(88.6±19.2)显著低于第二阶段(97.0±14.6)(P=0.004);第一阶段患儿智力发育指数<70的发生率(14.8%)显著高于第二阶段(3.4%)(P=0.014)。第一阶段患儿总体神经发育损害的发生率(22.2%)高于第二阶段(13.5%), 脑瘫发生率(9.3%)高于第二阶段(2.3%), 心理运动发育指数得分(83.6±16.1)低于第二阶段(85.0±13.6), 心理运动发育指数<70分的发生率(16.7%)高于第二阶段(12.4%), 但这几个方面的差异均无统计学意义。结论 医生和家长均应重视VLBWI和ELBWI的出院后随访及早期干预, 以改善患儿的神经发育预后。
Abstract
Objective To investigate changes of neurodevelopmental outcomes of very low birth weight infant (VLBWI) and extremely birth weight infant (ELBWI) occurred over the recent years. Methods The population included 143 VLBWI and ELBWI admitted from October 1st 2005 to December 31st 2010 who had finished the infant development test of BSID-Ⅱ at corrected gestational aged 18~42 months.The neurodevelopmental outcomes between two periods[2005-2008 (period 1);2009-2010 (period 2)]were compared. Results The subjects in two-period study were similar in gender, gestational age, and birth weight.The neurodevelopmental outcomes in period 2 improved:the MDI score was increased (97.0±14.6) versus (88.6±19.2)(P=0.004), and the rate of MDI<70 was decreased (3.4% versus 14.8%, P=0.014).In the period 1, the incidence of neurodevelopmental impairment and cerebral palsy were higher than the period 2 (22.2% versus 13.5%, 9.3% versus 2.3%), and the PDI score was lower[(83.6±16.1) versus (85.0±13.6)]and the rate of PDI<70 was higher (16.7% versus 12.4%).But these differences were not statistically significant. Conclusions Recent years, the neurodevelopmental outcomes of VLBWI and ELBWI seem to improve.Both doctors and parents should pay attention to the follow-up and early intervention of VLBWI and ELBWI after discharge, by which to improve their neurodevelopmental outcomes.
关键词
极低出生体重儿 /
超低出生体重儿 /
神经发育预后 /
变化趋势
Key words
very low birth weight infant /
extremely low birth weight infant /
neurodevelopmental outcome /
change trend
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参考文献
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基金
上海市自然科学基金重点项目(09JC1402700);NSFC-CIHR新生儿临床决策支持系统构建(中加健康研究合作计划)(81061120523)
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