目的 分析多胞胎和单胞胎早产儿的神经心理发育规律及影响因素,为促进早产儿出院后随访管理和早期采取干预措施提供依据。方法 选取2017年1月—2021年12月在温州市人民医院儿童保健科随访的535例早产儿作为研究对象,根据妊娠胎儿个数分为多胞胎组和单胞胎组,定期对其进行Gesell发育量表评估并记录其基本资料,比较两组神经发育规律及寻找其影响因素。结果 1)多胞胎组在纠正12月龄时适应性DQ值与单胞胎组差异有统计学意义(t＝2.773,P＜0.05)。2)纠正12月龄与纠正6月龄多胞胎组的适应性、大运动和语言DQ值差异有统计学意义(t分别为-2.038、-4.833、5.198,P＜0.05)。3)纠正12月龄与纠正6月龄单胞胎组的适应性、大运动、精细动作和语言DQ值差异有统计学意义(t分别为-6.547、-6.251、-4.441、4.738,P＜0.05)。4)Logistic回归分析显示,在控制混杂因素后,多胞胎是适应性发育异常的危险因素(OR=5.066,P=0.010),低出生体重是大运动发育异常的危险因素(OR=15.186,P=0.003),低出生胎龄是语言发育异常的危险因素(OR=2.225,P=0.005),低出生胎龄(OR=2.675,P<0.001)和男性(OR=3.844,P=0.026)是个人社交发育异常的危险因素。结论 多胞胎和单胞胎早产儿易出现语言和个人社交方面的发育落后,同时多胞胎早产儿也存在适应性发育障碍风险,针对影响早产儿发育的因素,应加强随访监测,并给予科学的干预指导。
Abstract
Objective To analyze the neurobehavioral development of preterm multiple births and singleton births, so as to provide reference for post discharge management and early intervention of preterm infants. Methods A total of 535 preterm infants who were followed up in the Department of Child Healthcare of Wenzhou People's Hospital from January 2017 to December 2021 were selected as the study subjects, and were divided into multiple births and singleton births groups according to the number of pregnant fetuses. Infants were assessed regularly by Gesell Developmental Scale and their general data were recorded. Neuropsychological development of infants in the two groups was compared and the influencing factors were analyzed. Results 1) At 12 months of corrected age, there were statistically significant differences in developmental quotient(DQ) values of adaptability between preterm multiple births and singleton births (t＝2.773, P<0.05). 2) For preterm multiples, there were statistically significant differences in DQ values of adaptability, gross motor movement and language between 6 months of corrected age and 12 months of corrected age (t＝-2.038, -4.833, 5.198, P<0.05). 3) For preterm singletons, there were statistically significant differences in DQ values of adaptability, gross motor movement, fine motor and language between 6 months of corrected age and 12 months of corrected age (t＝-6.547, -6.251, -4.441, 4.738, P<0.05). 4) After controlling for confounding factors, Logistic regression analysis showed that multiple birth was a risk factor for abnormal development of adaptability (OR=5.066,P=0.010), low birth weight was a risk factor for abnormal development of gross motor movement (OR=15.186,P=0.003), low gestational age was a risk factor for abnormal development of fine movement (OR=2.225,P=0.005), low gestational age(OR=2.675,P<0.001) and male (OR=3.844,P=0.026) were risk factors for abnormal development of social interaction. Conclusions Preterm multiple births and singleton births are prone to developmental delays in language and social interaction, and preterm multiple births are also at risk for adaptive developmental disorders. Therefore, follow-up monitoring should be strengthened and scientific intervention guidance should be given based on the factors affecting the development of premature infants.
关键词
早产儿 /
多胞胎 /
单胞胎 /
神经发育
Key words
preterm infants /
multiple births /
singleton birth /
neurobehavioral development
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