目的 比较不同出生胎龄的早产儿矫正24月龄内体格发育及神经发育情况,为进一步做好早产儿保健提供理论依据。方法 回顾性分析2017年1月—2020年8月在深圳市妇幼保健院高危儿门诊随访胎龄为23～36+6周的4 077例早产儿的体格及神经心理发育情况。其中男2 283例,女1 794例;根据胎龄分为超早产儿(<28周)、早期早产儿(28～31+6周)、中期早产儿(32～33+6周)和晚期早产儿(34～36+6周)。体格发育采用Z值法,神经心理发育采用贝利Ⅱ量表评估。统计分析各组年龄别体重Z值(WAZ)、年龄别身长Z值(LAZ)、年龄别头围Z值(HCZ)、智能发育指数(MDI)和运动发育指数(PDI),并绘制各矫正月龄体格及神经心理发育指标变化趋势。结果 1)各胎龄组各矫正月龄相应体格发育指标(包括WAZ、LAZ、HCZ)比较,差异均有统计学意义(P＜0.05),超早产儿组在各矫正月龄的各体格发育指标均小于其余胎龄组(P＜0.05),其他三组在矫正1、3、6及12月龄内的各体格发育指标比较,差异有统计学意义(P＜0.05),而在矫正18及24月龄各体格发育指标比较,差异无统计学意义(P>0.05);中、晚期早产儿组各矫正月龄各体格发育指标比较,差异均无统计学意义(P＞0.05)。各胎龄组WAZ及LAZ在矫正40周至矫正6月呈上升趋势,但在矫正6月至矫正18月出现下降趋势(F=5.572、4.867,P＜0.001)。而各胎龄组HCZ在矫正40周至矫正24月总体呈现下降趋势(F=3.095, P=0.006)。2)超早产儿组在各矫正月龄的MDI及PDI均小于其余胎龄组(F=22.134、31.729, P＜0.05)。早、中、晚期早产儿三组的MDI及PDI比较差异均无统计学意义(P＞0.05)。超早产儿组MDI在矫正6月至矫正24月龄呈下降趋势(F=8.972,P＜0.001)。结论 早、中、晚期早产儿在矫正24月龄内基本达到适宜的体格及神经心理发育,而超早产儿在矫正24月龄内的体格和神经心理发育仍不理想,需要进一步研究及干预。
Abstract
Objective To compare the physical and neuropsychological development of preterm infants with different gestational ages within 24 months of corrected age, so as to provide theoretical basis for further health care of preterm infants. Methods Data on the physical development and neurodevelopment of 4 077 subjects (including 2 283 male infants and 1 794 female infants), who participated in the follow-up management in the clinic of high-risk infants in Shenzhen Maternity and Child Health Hospital from January 2017 to August 2020 at 1, 3, 6,12, 18,24 months of corrected age, were respectively collected and analyzed. According to gestational age, preterm infants were divided into extremely preterm infants (<28 weeks), early preterm infants (28 - 31+6 weeks), mid-term preterm infants (32 - 33+6 weeks) and late preterm infants (34 - 36+6weeks). Physical development of infants was evaluated by the Z-score method, and the neurodevelopment was evaluated by the Bayley Ⅱ scales. Weight for ageZ value (WAZ), length for ageZ value (LAZ), head circumference for age Z value(HCZ), mental development index (MDI) and physical development index (PDI) for each group were analyzed, and the trend lines of physical and neurodevelopment index of each corrected age were drew. Results 1) Differences in the average physical development indicators (including WAZ, LAZ, HCZ) of each gestational age group for each corrected month age were statistically significant (P<0.05), and all physical development indicators of the extremely preterm infants group were less than the others at each corrected month age(P<0.05). Differences in the physical development indicators at 1, 3, 6 months and 12 months of age among early, mid-term and late preterm infants were significant(P<0.05), which were not significant at the corrected age of 18 and 24 months(P＞0.05). There were no significant differences in the scores of physical development indicators between the mid-term preterm infants and late preterm infants(P＞0.05). The WAZ and LAZ of each gestational age group showed an upward trend from corrected age of 40 weeks to 6 months, but showed a downward trend from corrected 6 months to 18 months (F=5.572, 4.867, P<0.001). The HCZ of each gestational age group showed an overall downward trend from corrected age of 40 weeks to 24 months (F=3.095, P=0.006). 2) The MDI and PDI of extremely preterm infants group were lower than those of the others at each corrected month age (F=22.134、31.729, P<0.05), but with no significant differences among early, mid-term and late preterm infants(P＞0.05). The MDI from 6 months to 24 months of age showed a downward trend in the extremely preterm infants group (F=8.972, P<0.001). Conclusion The physical and neuropsychological development of early, mid-term and late preterm infants within 24 months of corrected age is basically appropriate,which is still unsatisfactory in extremely preterm infants within 24 months of corrected age and requires further study and intervention.
关键词
早产儿 /
体格生长发育 /
神经心理发育
Key words
premature infants /
physical development /
neuropsychological development
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参考文献
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基金
中国疾病预防控制中心妇幼保健中心母婴营养与健康研究项目(2021FY009)
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