目的 探讨重度早产儿视网膜病变(ROP)早产儿的神经发育预后,评估早产儿视网膜病变是否合并神经发育落后,为其早期识别和干预提供依据。方法 采用回顾性队列研究分析2019年1月1日—2021年8月31日在郑州大学附属儿童医院住院的胎龄为25～32周的早产儿,患重度ROP的早产儿为ROP组,胎龄类似无ROP的早产儿为对照组。比较分析两组患儿在矫正月龄足月龄,矫正月龄3月及6月时的头颅核磁结果,统计分析两组患儿在矫正足月龄时新生儿行为神经评估量表(NBNA)评分,矫正3、6、12、18月龄及24月龄时智能发育指数(MDI)和精神运动发育指数(PDI)结局。结果 在矫正18月龄、24月龄时ROP组早产儿的MDI和PDI较对照组低(MDI:t=2.344、2.529,P＜0.05;PDI:t=2.043、2.378,P＜0.05)。其视力发生损伤(主要是屈光不正)较同期对照组早产儿发生率高(χ2=9.297,P=0.002),Logistic多元回归分析显示吸氧时间是后期精神运动发育障碍的危险因素(OR=1.031,95%CI:1.005~1.058,P=0.021)。结论 重度ROP早产儿经治疗后,视力影响以屈光不正多见;在矫正18～24月龄时,MDI与PDI均落后于同龄早产儿。建议进一步研究年长ROP儿童的神经发育是否落后于同龄早产儿。
Abstract
Objective To investigate the neurodevelopmental prognosis of premature infants with severe retinopathy of prematurity (ROP), and to assess whether ROP is associated with neurodevelopmental delay, so as to provide evidence for early identification and intervention. Methods A retrospective cohort study was conducted to analyze premature infants with a gestational age of 25 - 32 weeks admitted to the Children's Hospital Affliated to Zhengzhou University from January 1, 2019 to August 31,2021. Infants with severe ROP were assigned to the ROP group, while those with similar gestational ages but without ROP served as the control group.The cranial magnetic resonance imaging (MRI) results of both groups were compared at corrected full-term age, 3 months, and 6 months of corrected age. The Neonatal Behavioral Neurological Assessment (NBNA) scores at corrected full-term age, and the mental development index (MDI) and psychomotor development index (PDI) outcomes at 3, 6, 12, 18, and 24 months of corrected age were statistically analyzed. Results At 18 and 24 months of corrected age, the MDI and PDI scores of the ROP group were lower than those of the control group (MDI: t=2.344, 2.529, P<0.05; PDI: t=2.043, 2.378, P<0.05).The incidence of visual abnormalities (primarily ametropia) was significantly higher in the ROP group compared to the control group at the same time points (χ2=9.297, P=0.002).Logistic regression analysis revealed that oxygen therapy duration was a risk factor for later psychomotor developmental delay (OR=1.031, 95%CI: 1.005 - 1.058, P=0.021). Conclusions After treatment, visual impairment in premature infants with severe ROP is primarily manifested as refractive errors.At 18 - 24 months of corrected age, their MDI and PDI scores lag behind those of age-matched premature infants without ROP. Further research is recommended to investigate whether older children with ROP experience neurodevelopmental delays compared to preterm infants with the same age.
关键词
早产儿视网膜病变 /
神经发育 /
视力 /
听力
Key words
retinopathy of prematurity /
neurodevelopment /
vision /
hearing
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参考文献
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基金
河南省中青年卫生健康科技创新人才培养领军人才项目(YXKC2021022)
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