目的 了解高危儿出院后有关营养和神经系统发育等方面情况,以更好指导后期随访提供依据。 方法 共选取2019年6月1日—2020年7月1日在南通大学附属常州儿童医院高危儿联合门诊进行随访的293例B类高危儿为研究对象,分别对高危儿疾病病种、随访依从性、纯母乳喂养率、营养发育和神经系统发育等随访数据进行分析。 结果 高危儿随访病种位于前三位的是早产、肺炎和重度黄疸。随访依从性好为43.0%;纯母乳喂养率为32.8%;营养不良和营养过剩发生率分别为14.0%和9.2%。并且293例B类高危儿中有49例患儿因存在脑损伤高危因素或已有神经系统发育异常,生后3个月行Gesell的评分,其5项评分中,得分低于对应年龄最多的是应物能方面,应物能力落后占比为55.1%;落后天数最多的是精细运动方面,平均落后正常儿童41.8天;并且这49例中Gesell评估全部异常的有8例,其中早产儿有6例。早产高危儿与足月高危儿相比纯母乳喂养率、精细运动落后天数、应物能落后天数和言语能落后天数比较,差异有统计学意义(χ²=32.47、2.46、2.23、2.19,P＜0.05)。结论 对B类高危儿随访的数据进行信息化管理,及时分析获取有关随访结果,对提高随访依从性、母乳喂养率和加强早产高危儿的精细运动锻炼具有一定指导作用。

Objective To summarize and analyze the follow-up data of high-risk infants, and to understand the results of nutrition and nervous system development of high-risk infants after discharge, so as to better guide the follow-up work. Methods A total of 293 high-risk infants were selected from type B high-risk children who were followed up in the combined outpatient department of Changzhou Children's Hospital from June 1st, 2019 to July 1st, 2020.The follow-up data of high-risk diseases, follow-up compliance, exclusive breastfeeding rate, nutritional development and nervous system development were analyzed. Results Preterm birth, pneumonia and severe jaundice were the top three diseases in the follow-up of high-risk children.Follow-up compliance was only 43.0%.The follow-up rate of exclusive breast-feeding was 32.8%.The prevalence rates of malnutrition and overnutrition were 14.0% and 9.2%, respectively.In addition, 49 of the 293 type B high-risk children were at risk of brain injury or had abnormal nervous system development, and were assessed by Gesell at 3 months after birth.Among the five areas, the largest gap between Gesell score and the corresponding age was in the aspect of adaptive area, accounted for 55.1%.The highest number of days behind was in fine motor activities, with an average lag of 41.8 days than normal children.There were eight children assessed entirely abnormal by Gesell, of whom six were preterm infants.Compared with the full-term high-risk infants, the preterm high-risk infants had statistically significant differences in the exclusive breastfeeding rate, the days of fine motor delay, the days of delayed response ability and the days of delayed speech ability (χ²=32.47, 2.46, 2.23, 2.19,P＜0.05). Conclusions It is suggested that information management should be carried out for the follow-up data of type B high-risk infants, and timely analysis should be made to obtain the relevant follow-up results, which has a certain guiding role in improving the follow-up compliance, breastfeeding rate and strengthening the fine motor exercise of children with brain injury, especially the premature high-risk infants.