目的 对极低出生体重儿和胎龄<32周早产儿进行早期干预,观察能否降低其脑瘫发生率。方法 出生于28家医院胎龄<32周或/和出生体重<1 500 g的早产儿857例,除外先天畸形和先天遗传代谢疾病,分为两组:研究开始后出生的早产儿,家长参与早期干预指导的为干预组(452例);研究开始前9~15月内出生的早产儿,家庭常规育儿方式养育者为对照组(405例)。干预组患儿出院后即按早期干预计划(运动、认知、语言、情感、交往能力)等进行干预。运动训练,包括按摩、被动操、主动运动训练等。每月做神经运动检查,若出现异常者做家庭强化训练;对照组只和干预组接受同样的喂养、护理和婴幼儿保健指导。对照组在矫正年龄9、12个月做神经运动检查,继续随访到2岁。结果 两组在性别、胎龄、出生体重等差异无统计学意义(P>0.05)。围生期情况比较,颅内出血干预组(26.33%)高于对照组(18.43%)(P<0.05)。宫内窘迫、生后窒息、缺氧缺血性脑病,高胆红素血症、呼吸窘迫综合症、新生儿感染的发生比例两组比较无统计学意义(P均>0.05)。两组患儿诊断脑瘫时间均在1岁以后。干预组脑瘫发生率为22.1‰(10/452),对照组为61.7‰(25/405)。对照组高于干预组2.79倍,差异有高度统计学意义(P<0.01)。结论 出院后开始早期干预可有效降低早产儿和极低出生体重儿的脑瘫发生率。

Objective To investigate whether early intervention on premature very low birth weight infants can reduce the incidence of cerebral palsy. Methods The sample data in this study included 857 premature infants with gestational age less than 32 weeks and/or birth weight lower than 1 500 g from 28 hospitals.The children with congenital malformations and hereditary diseases were excluded.All children were divided into two groups: intervention group (452) in which their parents actively received early intervention guidance and control group (405) in which all children were born 9 to 15 months prior the study and were only given conventional parenting.A comprehensive early intervention program was performed to children in intervention group after discharge from hospitals,including the training of motor,cognitive,language,emotional and communication abilities.Among them,Motor training included massage,passive exercise and active exercise training.Children were then taken neuromotor examination once a month.Children with abnormal posture received intensive training by professional rehabilitation personnel; children in control group only received the same feeding,care and infant health guidance with children in the intervention group.Subjects were then taken neuromotor examination on the corrected age of 9 and 12 months respectively.All children were followed up to 2 years old. Results Children in two groups were without difference in gender,gestational age,birth weight and other general aspects (P>0.05).Perinatal period comparison:There were 118 (26.33%) and 75 (18.43%) children were found with intracranial hemorrhage in the intervention and control group respectively.The occurrence of intracranial hemorrhage in the intervention group was significantly higher (P<0.05).The comparisons of the incidence ratios of intrauterine distress,postnatal asphyxia,hypoxic-ischemic encephalopathy,hyperbilirubinemia,respiratory distress syndrome and neonatal infection were statistically insignificant (all P>0.05).The diagnoses of cerebral palsy were given only when children were older than 1 in both groups.The incidence of cerebral palsy was 22.1 ‰(10/452) in the intervention group,and 61.7 ‰(25/405) in control group,the incidence ratio in the control group was 2.79 times higher,and the difference was statistically significant (P<0.01). Conclusion Early intervention can effectively reduce incidence of cerebral palsy in premature children and very low birth weight children after discharge.