目的 分析多学科合作系统管理和早期综合干预对新生儿重症监护室(NICU)出院早产儿近期神经发育结局的影响。方法 回顾分析和比较在上海市儿童医院早产儿整合门诊接受随访的早产儿,根据管理模式分为非系统管理且无干预阶段,以及多学科合作开展系统管理阶段,比较两阶段NICU出院早产儿发育迟缓发生率;通过对照研究评价多学科合作的系统管理对NICU早产儿近期神经发育结局的影响。结果 1999年1月-2016年6月累计登记随访NICU出院早产儿997例,两阶段中早产儿随访至校正12月龄段时,系统管理下的早产儿各能区发育迟缓发生率较低(P<0.05)。对照研究表明,NICU出院早产儿接受系统管理后,校正18月龄发育商可达平均水平。结论 多学科合作开展系统的随访管理,能改善NICU出院早产儿近期神经精神发育结局。
Abstract
Objective To analyze the impact of systematically follow-up and early intervention on the recent neurodevelopmental outcomes of neonatal intensive care unit (NICU) preterm infants in a multidisciplinary team (MDT) framework. Methods Retrospective analysis and intervention-controlled study were conducted.The developmental abnormalities ratio of the recorded preterm infants discharged from Shanghai Children's Hospital were analyzed and the outcomes were compared with those under systematically follow-up and early intervention The impact of MDT systematically follow-up and early intervention on the neurodevelopmental outcomes of NICU preterm infants were evaluated through a prospective intervention-controlled study. Results Totally 997 infants discharged from NICU were recorded and analyzed from Jan. 1999 to Jun.2016 Infants with systematically follow-up and early intervention had lower developmental abnormalities ratio (P<0.05).Intervention-controlled study further showed that infants in intervention group could be developed to the average scores. Conclusion Preterm infants discharged from NICU need systematically follow-up and effectively early intervention by specialist in a MDT framework to make sure a better outcome.
关键词
多学科合作 /
新生儿重症监护室 /
早产儿 /
系统管理
Key words
multidisciplinary cooperation /
neonatal intensive care unit /
preterm infants /
systematic management
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参考文献
[1] 冯江,袁秀琴,朱军,等.中国2000-2010年5岁以下儿童死亡率和死亡原因分析[J].中华流行病学杂志,2012,33(6):558-562.
[2] Vohr B.Long-term outcomes of moderately preterm,late preterm,and early term infants[J].Clin Perinatol,2013,40(4):739-751.
[3] Spittle A,Orton J,Anderson PJ,et al.Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants[J].Cochrane Database Syst Rev,2015,11:D5495.
[4] 陈超,魏克伦,姚裕家,等.早产儿管理指南[J].中华儿科杂志,2006,44(3):188-191.
[5] Saigal S,Doyle L W.An overview of mortality and sequelae of preterm birth from infancy to adulthood[J].Lancet,2008,371(9608):261-269.
[6] 李小燕,王慧琴,柴竹青,等.早产儿出院后生长发育监测与随访[J].中国儿童保健杂志,2016,24(7):749-752.
[7] 汤淑斌,杜亚梅,胡春维,等.早期综合干预对早产儿早期发育商的影响[J].中国儿童保健杂志,2014,22(12):1331-1333.
[8] Malcolm WF.Beyond the NICU:comprehensive care of The high-risk infant[M].United States of Amercia:McGraw-Hill Educantion,2015.
[9] Als H,Duffy FH,Mcanulty G,et al.NIDCAP improves brain function and structure in preterm infants with severe intrauterine growth restriction[J].J Perinatol,2012,32(10):797-803.
[10] Benzies KM,Magill-Evans JE,Hayden KA,et al.Key components of early intervention programs for preterm infants and their parents:a systematic review and meta-analysis[J].BMC Pregnancy Childbirth,2013,13 (Suppl 1):10.
[11] 赵凯怡,赵芸,潘静子,等.极低出生体重儿和极早早产儿随访检测及预后影响因素分析[J].中华物理医学与康复杂志,2015,37(1):24-28.
[12] 成磊,冯升,陆春梅,等.早产儿出院后父母照顾体验质性研究的系统评价和Meta整合[J].中国循证医学杂志,2015,15(9):1090-1097.
基金
上海市第四轮加强公共卫生体系建设三年行动计划(2015-2017)多学科合作的高危儿综合管理(GWIV-19);上海申康医院发展中心社区适宜技术项目资助(SHDC12014203);上海市科学技术委员会科技成果转化和产业化项目(16511104903)
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