目的 对比早产儿与足月儿早期0~1岁神经运动20项检查(INMA20)结果的差异,为神经发育异常患儿的早发现、早干预提供新思路。方法 选择2020年1月1日—12月31日出生并在四川大学华西第二医院儿童保健科建档进行连续随访的婴儿,根据孕周分为早产儿组与足月儿组,分析两组婴儿首次儿童保健时INMA20结果差异。结果 共纳入早产儿349例,足月儿713例。INMA20检查各维度结果显示早产儿视听反应维度异常率(13.5%)明显高于足月儿(8.4%)(χ²=6.683,P=0.010),足月儿肌张力维度异常率(50.9%)显著高于早产儿(44.0%)(χ²=4.517,P=0.034),两组间反射、姿势维度以及总结果,差异无统计学意义(P＞0.05)。各检查条目结果显示,早产儿的人脸追踪、内收肌角及足背屈曲异常率明显高于足月儿(χ²=7.307、3.932,P＜0.05),而足月儿持续手握拳、拉坐姿势和头竖立、围巾征异常率显著高于早产儿(χ²=5.936、11.058、6.669,P＜0.05) 。结论 早期发育中,早产儿视听整合能力、下肢肌力较弱、足月儿上肢肌力较高而头颈部肌力较弱。建议在常规儿童保健中加强视听整合训练促进早产儿视听觉追赶发育,开展不同类型的运动干预以促进婴儿粗大运动发育,同时进行早期运动发育评估尽早发现发育异常的婴儿。

Objective To compare the difference in Infant Neurological Motor Assessment 20 Items(INMA20) results between preterm and full-term infants, so as to provide new clues for early detection and early intervention of children with neurodevelopmental abnormalities. Methods Infants born from January 1st to December 31st 2020 and followed up continuously in the Department of Child Health Care, West China Second University were enrolled in this study, and were divided into preterm group and full-term group according to gestational age. The difference in INMA20 results between the two groups was analyzed. Results A total of 349 premature infants and 713 full-term infants were enrolled. Failure rate of visual and auditory response dimension in preterm infants(13.5%) was higher than that in full-term infants(8.4%)(χ²=6.683,P=0.010), and failure rate of muscle tension dimension in full-term infants(50.9%) was higher than that in preterm infants(44.0%)(χ²=4.517, P=0.034), but no differences were found in reflex, posture and final results(P＞0.05). Besides, the results of each item showed that the failure rates of face tracking, adductors angle and dorsalis pedis flexion angle in preterm infants were significantly higher than those in full-term infants(χ²=7.307,3.932,P＜0.05), while the failure rates of continuous fist holding, pull sitting posture and head upright and scarf sign in full-term infants were significantly higher than those in preterm infants(χ²=5.936,11.058,6.669, P＜0.05). Conclusions Preterm infants have weaker audiovisual integration and lower limb muscles, while full-term infants have higher upper limb muscles and weaker head and neck muscles. It is suggested strengthening audiovisual integration training in routine child healthcare so as to promote audiovisual catch-up development in preterm infants, and taking motor interventions in order to promote gross motor development. Meanwhile, early motor development assessments should be conducted to identify infants with developmental abnormalities as early as possible.