目的 分析双胎发育不均衡早产儿生后早期并发症及纠正年龄12月时神经发育的差异,为双胎发育不均衡早产儿预防并发症提供依据。方法 采用前瞻性队列研究,选择2016年1月1日-2017年12月31日郑州大学第三附属医院新生儿科收治的活产、双胎且出生体重差异≥25%,除外双胎输血综合征的早产儿67对,分为轻胎组67例,重胎组67例,观察其生后早期并发症和纠正年龄12月以内的神经发育发育情况。结果 1)轻胎组发生新生儿呼吸窘迫综合征(NRDS)、喂养不耐受和感染性疾病的比例,住院期间放弃或死亡例数及住院天数均高于重胎组,差异有统计学意义(t=4.418、4.251、3.983、5.858、4.733,P＜0.05)。2)双胎均痊愈出院者共55对,随访至纠正年龄12月者43对。在不同出生胎龄中(＜32周,32~33⁺⁶周,34~36⁺⁶周),轻胎组新生儿行为神经测定(NBNA)得分均显著低于重胎组(6月龄:t=3.735、2.494、2.129;12龄:t=4.850、3.269、3.381,P＜0.001);纠正年龄6月和12月龄时,不同胎龄中,轻胎组与重胎组智力发育指数(MDI)差异均无统计学意义(P>0.05),而轻胎组运动发育指数(PDI)均显著低于重胎组(t=4.269、3.233、2.578,P＜0.01)。结论 双胎发育不均衡的早产儿中,低出生体重小者生后早期并发症多,预后不良的发生率较高,要严密随访,尤其注意运动能力的发育状况。

Objective To study the early complications and neurological prognosis within 12 months of corrected age in twin preterms with birth weight discordance,in order to provide evidence for the prevention of complications in twin preterms with birth weight discordance. Methods A prospective cohort study was conducted.a total of 67 pairs of live twin preterms with birth weight discordance≥25% but without twin to twin transfusion syndrome hospitalized in the neonatal department of the Third Affiliated Hospital of Zhengzhou University from January 1,2016 to December 31,2017 were included,and were divided into low birth weight group and high birth weight group.The early complications and neurological prognosis within 12 months of corrected age were observed. Results 1)The rates of neonatal respiratory distress syndrome (NRDS),feeding intolerance and infectious diseases were significantly higher in the low birthweight group than in the high birth weight group (t=4.418,4.251,3.983,5.858,4.733,P<0.05).2)A total of 55 pairs of twins were both cured and 43 pairs were followed up to 12 months of correct age.In different gestational age groups (＜32 weeks,32-33⁺⁶ weeks and 34-36⁺⁶weeks),neonatal behavioral neurological assessment (NBNA) scores in low birthweight group were significantly lower than that of heavy birthweight group (t=4.850,3.269,3.381,P<0.05).There was no statistical difference in mental development index (MDI) between the two groups among different gestational age groups at 6 and 12 months of correct age respectively,while psychomotor development index (PDI) in the low birth weight group was lower than that of high birth weight group with statistical difference among different gestational age groups at 6 and 12 months of correct age (6months t=3.735,2.494,2.129;12months t=4.269,3.233,2.578,P<0.05). Conclusions In the twin preterms with birth weight discordance,those with low birthweight have more complications and a higher incidence of poor prognosis.Therefore,strict follow-up should be taken to those patients,and more attention should be paid to the psychomotor development.