目的 了解上海市低出生体重儿(LBW)头围与18月龄神经行为发育水平的关系,为低出生体重儿神经行为发育迟缓的早期识别提供参考依据。方法 采用前瞻性人群队列研究,将符合纳入标准的2016年3月—2018年10月在上海16个区妇幼保健院(所)登记并进行健康系统管理的LBW作为研究对象,进行问卷调查、各随访月龄头围测量、18月龄Gesell发育诊断评估。结果 本研究共调查758例上海市LBW,男童329人(43.4％),女童429人(56.6%),平均出生体重(2 223.00±231.13)g,平均胎龄(35.78±1.92)周。采用Logistic回归分析发现,年龄别头围Z评分(HCZ)1月龄、HCZ3月龄、HCZ6月龄＜-1组LBW在精细动作行为能区发育异常风险显著升高(OR=6.97、3.07、2.96,P<0.05);各随访月龄HCZ＜-1组LBW在适应行为能区发育异常风险显著升高(OR=3.39、3.28、2.65、3.25、3.29、2.67,P<0.05);HCZ1月龄、HCZ3月龄、HCZ6月龄、HCZ6月龄、HCZ12月龄＜-1组LBW在语言行为能区发育异常风险显著升高(OR=4.28、3.32、2.62、3.95、2.90,P<0.05)。采用多元线性回归分析发现,HCZ1月龄对精细动作行为能区和语言行为能区发育异常、HCZ6月龄对适应行为能区发育异常具有较好的预测作用(R2=0.052、0.063、0.046),标准化回归系数显示,各随访月龄HCZ对于语言行为能区发育异常的预测贡献较大(β=0.180、0.165、0.158、0.139、0.136、0.113)。结论 头围对LBW18月龄神经行为发育水平具有一定的预测价值,关注LBW头围随访,对早期识别和干预神经行为发育迟缓具有重要意义。
Abstract
Objective To investigate the correlation between head circumference and neurobehavioral development of low birth weight(LBW) infants 18-month in Shanghai, so as to provide evidence for early recognition of LBW neurobehavioral retardation. Methods A prospective cohort study was conducted. Children registered and managed in Maternal and Child Health Care Hospitals of 16 districts in Shanghai from March 2016 to October 2018 were selected into this study. Questionnaire survey, head circumference measurement and Gesell developmental diagnosis were conducted on the enrolled subjects. Results A total of 758 LBW infants [329 boys(43.4%) and 429 girls(56.6%)] were included in this study, with an average birth weight of (2 223±231.13)g and an average gestational age of(35.78±1.92) weeks. Logistic regression analysis showed that the risk of abnormal development in LBW fine motor significantly increased in (head circumference-for-age Z-score,HCZ)1-month, HCZ3-month,HCZ6-month<-1 groups(OR=6.97, 3.07, 2.96, P<0.05). The risk of abnormal development in LBW adaptive behavior significantly increased in HCZ <-1 group at all follow-up months(OR=3.39, 3.28, 2.65, 3.25, 3.29, 2.67, P<0.05). The risk of abnormal development in LBW language significantly increased in HCZ1-month, HCZ3-month,HCZ6-month, HCZ9-month, HCZ12-month<-1 groups(OR=4.28, 3.32, 2.62, 3.95, 2.90, P<0.05). Multiple linear regression analysis showed that HCZ1-month was a good predictor to the dysplasia of LBW fine motor and language, and HCZ6-month could predict the dysplasia of LBW adaptive behavior to a certain extent(R2=0.052, 0.063, 0.046). Standardized regression coefficients showed that HCZ had significant contribution to the prediction of abnormal language development at each follow-up month(β=0.180, 0.165, 0.158, 0.139, 0.136, 0.113). Conclusions Head circumference has a predictive effect on the outcome of neurobehavioral development of low birth weight infants within 18 months old. Focusing on the follow-up of head circumference in LBW is important for early identification and intervention of neurobehavioral developmental delay.
关键词
低出生体重儿 /
头围 /
神经行为发育
Key words
low birth weight infants /
head circumference /
neurobehavioral development
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参考文献
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基金
上海市卫生健康委员会科研课题(201840093);上海市公共卫生体系建设三年行动计划项目(2015-2017)(GWIV 14.1)
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