目的 探讨极低出生体重坏死性小肠结肠炎(NEC)患儿在纠正胎龄3月、6月、9月、12月时体格和神经发育的研究,为极低出生体重儿并发NEC的干预提供依据。方法 回顾性收集2018年4月—2021年4月西安交通大学第二附属医院新生儿门诊随访的极低出生体重NEC患儿及非NEC(无NEC)患儿的临床资料。分析不同NEC分期组患儿围生期的体格特点,比较各组患儿在纠正胎龄3月、6月、9月、12月时体格及神经发育研究。结果 1)总病例数122例,无NEC组51例,NEC组71例,参考修正版Bell分期,分为NEC-Ⅱ期39例,NEC-Ⅲ期32例,三组间出生体重、胎龄、头围、身长及性别比较,差异均无统计学意义(P＞0.05);2)无NEC组、NEC-Ⅱ期、NEC-Ⅲ期组三组间在纠正胎龄3月、6月、9月、12月时体重(F值分别为13.31、11.16、10.28、8.56)、身长(F值分别为11.14、7.32、4.72、8.18)、头围(F值分别为9.69、6.88、10.42、7.71)比较,差异均有统计学意义(P＜0.05);3)无NEC组、NEC-Ⅱ期、NEC-Ⅲ期组三组间在纠正胎龄3月、6月、9月、12月龄时贝利婴幼儿发展量表Ⅱ(BSID-Ⅱ)的智能发育指数(MDI,F值分别为16.72、13.25、18.58、11.45)和精神运动发育指数(PDI,F值分别为17.58、15.32、18.66、15.43)比较,差异均有统计学意义(P＜0.05)。结论 NEC患儿体格和神经发育结局与出生胎龄、出生体重及并发症等多种因素有关,应重视NEC高危患儿的精细化管理,减少NEC发生及严重程度,改善患儿的远期预后。
Abstract
Objectives To investigate physical and neurodevelopment of neonatal necrotizing enterocolitis(NEC) in very low birth weight(VLBW) infants at correct gestational age of 3, 6, 9, and 12 months, in order to provide reference for the intervention of NEC. Method A retrospective case-control study was performed to collect data of VLBW infants with NEC and without NEC who were followed up in the Neonatal Outpatient of the Second Affiliated Hospital of Xi′an Jiaotong University from April 2018 to April 2021. The perinatal characteristics of infants in different NEC stages were analyzed, the physical and neurological development of infants in each group were compared at correct gestational age of 3, 6, 9 and 12 months. Results 1) A total of 122 cases were enrolled, including 51 cases in non-NEC group and 71 cases in NEC group. According to the modified Bell staging, there were 39 cases in NEC Stage Ⅱ and 32 cases in NEC Stage Ⅲ. There were no significant differences in birth weight, gestational age, head circumference, body length and gender among the NEC- stage Ⅱ group, stage Ⅲ group and non-NEC groups(P＞0.05). 2) There was significant difference in the physical development at correct gestational age of 3, 6, 9, and 12 months among the NEC- stage Ⅱ group, stage Ⅲ group and non-NEC groups(birth weight F=13.31, 11.16, 10.28, 8.56; body length F=11.14, 7.32, 4.72, 8.18; head circumference F=9.69, 6.88, 10.42, 7.71, P＜0.05). 3) There was significant difference in the mental developmental index(MDI)/psychomotor developmental index(PDI) scores of Bayley Scales of Infant Development-Ⅱ(BSID-Ⅱ) at correct gestational age of 3 month(F=17.58,16.72), 6 month(F=15.32,13.25), 9 month(F=18.66, 18.58), and 12 months(F=15.43, 11.45) among the NEC-stage Ⅱ group, stage Ⅲ group and non-NEC groups(P＜0.05). Conclusions Neurodevelopmental outcomes in children with NEC are related to multiple factors, including gestational age, birth weight and complications, etc. Therefore, it is supposed to pay more attention to the delicacy management of children at high risk of NEC to reduce the occurrence and severity of NEC, so as to improve the long-term prognosis of these children.
关键词
新生儿坏死性小肠结肠炎 /
极低出生体重儿 /
精神运动发育指数 /
智能发育指数 /
神经发育
Key words
neonatal necrotizing enterocolitis /
very low birth weight infants /
psychomotor developmental index /
mental developmental index /
neurodevelopment
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