目的 研究30~34周小于胎龄儿(SGA)与同胎龄适于胎龄儿(AGA)校正18~24月时神经发育的差异,为临床上完善早产儿的诊疗和早期干预提供理论依据。方法 前瞻性队列研究设计,广州市妇女儿童医疗中心于2015年1月-2017年12月对高危儿门诊随访的出生胎龄30~34周高危儿病例,按胎龄与出生体重分为SGA组与AGA组,比较两组早产儿一般出生情况、围产因素、早期合并症以及校正6~12月、18~24月龄时体格增长和神经发育情况,同时分析SGA早产儿早期并发症对神经发育的影响。结果 纳入研究的随访早产儿共122例,SGA组58例,AGA组64例,两组早产儿围产及早期合并症基本情况比较,差异无统计学意义(P>0.05)。校正6~12月龄时SGA组适应性、大运动、精细运动和语言发育商比较,均低于对照组,差异有统计学意义(P<0.05),两组个人社交发育商比较,差异无统计学意义(P>0.05)。校正18~24月龄时SGA组大运动和精细运动发育商低于对照组,差异有统计学意义(P<0.05),两组适应性、语言和个人社交发育商比较,差异无统计学意义(P>0.05)。早期合并支气管肺发育不良的SGA早产儿发生神经发育迟缓(发育商≤75)比例高于对照组,差异有统计学意义(P<0.05)。结论 SGA早产儿校正18~24月龄时大运动及精细运动发育商落后于同胎龄AGA早产儿,早期合并支气管肺发育不良(BPD)可能为神经发育迟缓的潜在危险因素。
Abstract
Objective To study neurodevelopmental outcomes at the age of 18-24 months in small for gestational age preterm infants with gestational age of 30-34 weeks,in order to provide theoretical basis for clinical improvement of diagnosis,treatment and early intervention in preterm infants. Methods A prospective cohort study was adopted. Premature infants,who were born at gestational age of 30-34 weeks and received regular follow-up management at high-risk infant outpatient clinic in Guangzhou Women and Children's Medical Center,were enrolled in this study from January 2015 to December 2017. And the participants were divided into small for gestational age (SGA) group and appropriate for gestational age (AGA) group. Birth data,perinatal factors,early complications,physical growth and neurodevelopmental outcomes between SGA group and AGA group were compared,also the effect of early complications of SGA infants on neurodevelopmental outcomes was observed. Results A total of 122 follow-up preterm infants were included in the study,with 58 in SGA group and 64 in AGA group. There was no significant differences on perinatal and postnatal complications between the two groups (P>0.05).Theadaptability,gross motor,fine motor and language in SGA group at the adjusted age of 6-12 months old were inferior to those of control group(P<0.05),while individual social development was not significantly different between the two groups (P>0.05). The gross motor and fine motor in SGA group at the adjusted age of 18-24 months old were inferior to those of control group(P<0.05),while the adaptability,language and individual social development were not significantly different between the two groups (P>0.05). Preterm infants with bronchopulmonary dysplasia were more likely to develop neurodevelopmental retardation (DQ≤75),and the difference was significant (P<0.05). Conclusions The gross motor and fine motor in SGA infants at the adjusted age of 18-24 months old lag behind AGA infants at the same age. And bronchopulmonary dysplasial(BPD) may be a potential risk factor for neurodevelopmental retardation.
关键词
小于胎龄儿 /
神经发育 /
早产儿
Key words
small for gestational age /
neurodevelopment /
preterm infants
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基金
广东省科技厅科技计划项目(2017A020214002)
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