目的 分析晚期早产儿神经运动和心理行为发育状况,为早期干预、预防不良神经发育学结局提供依据。方法 将2013年10月-2015年10月出生的,在西安市妇幼保健院早期综合发展门诊定期体检的102名晚期早产儿(LPIs)设为LPIs组, 153名同期出生的健康足月儿(FTIs)为FTIs组,根据围生期高危因素将晚期早产组分为LPIs 1组(无高危因素)和LPIs 2组(有高危因素)。所有研究对象在24～30月龄时进行神经发育学评估,比较LPIs组和FTIs组的运动障碍发生率,以及LPIs 1组,LPIs 2组和FTIs组组间Gesll发育诊断量表(GDDS)中的发育商(DQ)、儿童感觉统合发展检核量表和S-M社会生活能力量表测评分数。结果 LPIs组运动障碍的发生率高于FTIs组;LPIs1组、LPIs2组和FTIs组GDDS的各领域DQ值,感觉统合发展检核量表中的脑神经抑制困难以及S-M社会生活能力量表分数存在组间差异(P<0.001),LPIs1组,LPIs2组在上述测评中均明显落后于FTIs组(P<0.05),而LPIs1组与LPIs2组组内差异无统计学意义(P>0.05)。多元线性回归分析:妊高症是晚期早产儿S-M社会生活能力、适应性、个人-社交、语言的风险因素(P均<0.05);胎膜早破是S-M社会生活能力、适应性、精细运动、大动作的风险因素(P均<0.05);胎龄是脑神经抑制、大运动的风险因素(P均<0.05);出生体重是脑神经抑制、精细运动的风险因素(P均<0.05)。结论 晚期早产儿神经发育结局不容乐观,应加强对他们的发育监测,减少不良发育结局。
Abstract
Objective To analyze the neuromotor,psychological and behavioral development of late preterm infants(LPIs),and to give advice on early intervention to avoid the abnormal neurodevelopment outcome. Methods A total of 102 LPIs and 153 healthy full term infants (FTIs) with the same age were chosen as LPIs group and FTIs group respectively.LPIs group was also subdivided into LPIs1 group (without risk factors) and LPIs2 group (with risk factors) by prenatal risk factors.Neurodevelopmental tests were completed when they were 24～30 months:Incidence of motor disorders (MD) was compared between the two groups.Development quotient (DQ) of Gesell Development Diagnosis Scale (GDDS),scores of Sensory Integrative Development Checklist for Child and S-M Social Living Capacity Scale were compared among LPIs1,LPIs2 and FTIs groups. Results Incidence of MD in LIPs group was significantly higher than that in LPIs group.Compared among LPIs1,LPIs2 and FTIs group,DQ of GDDS,scores of S-M Social Living Capacity Scale and Physiological Inhibition of Cranial Nerves in Sensory Integrative Development Checklist for children were significantly different in interior-group (all P<0.001).Infants in LPIs1 and LPIs2 group performed inferior to their partners in FTIs group in the tests above(all P<0.05).Between the subgroups,there was no significant difference in the tests (P>0.05).Multiple linear regression analysis showed that pregnancy-induced hypertension was risk factor for S-M Social living capacity,adaptability,individual-social communication and language(all P<0.05).Premature rupture of fetal membranes was risk to S-M social living capacity,adaptability,fine motor and gross motor (all P<0.05).Gestational age was the risk factor for cerebral nerve suppression disorder and gross motor (all P<0.05).Birth weight was the risk factor for cerebral nerve suppression disorder and fine motor (all P<0.05). Conclusions The ending of neuropsychic behavior development of late preterm infants is not optimistic.Development monitoring should be strengthened in order to reduce bad development ending.
关键词
晚期早产儿 /
运动障碍 /
感觉统合发展 /
社会生活能力
Key words
late preterm infants /
motor disorders /
sensory integrative development /
social living capacity
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