NICU出院早产儿1岁时神经发育预后及干预依从性对其的影响

Neurodevelopmental outcome of preterm infants discharged from NICU at 1 year of age and the effects of intervention compliance on neurodevelopmental outcome

目的了解NICU抢救存活早产儿在1岁时的神经发育状况及其影响因素，重点讨论干预依从性对其预后的影响。方法患儿出院后予以早期干预指导和随访，1岁时进行智能发育测试（CDCC）评估，了解神经发育概况。按照智力发育指数（MDI）和精神运动发育指数（PDI）将患儿分为神经行为发育异常组（MDI或PDI任何一项〈70）、临界组（MDI或PDI任何一项为70～85之间）和正常组（MDI或PDI均〉85）。列举可能对神经行为发育产生影响的社会家庭因素和临床相关因素，利用单因素方差分析和卡方检验的方法进行筛选，对于可能的高危因素进行logistic回归分析，了解各因素相对危险度。根据家长对患儿进行干预的具体情况将其分为依从性良好（每周进行家庭干预〉14d，每天干预时间合计超过30min，并在1年内能够随访≥5次）和依从性差二组，进一步分析干预依从性对其神经发育预后的影响。结果210例患儿CDCC评分正常、临界和异常者分别为123例（58．6％）、61例（29．0％）和26例（12．4％），共有精神发育落后儿18例（8．6％）和脑瘫儿9例（4．3％）。干预依从性良好者（111例）的MDI及PDI得分，分别为97．15±17．38，94．23±18．55均明显高于干预依从性差者的89．87±18．92。87．20±19．12；干预依从性好组脑瘫的发生率（3／111，2．7％）也低于干预依从性差者（5／99，6．1％）。另外，父母亲文化水平、多胎、颅内出血、呼吸暂停等也是影响早产儿神经发育预后的危险因素。结论早产儿是神经发育伤残的高危人群，尤其是NICU抢救成活的危重新生儿。早期干预可以改善高危早产儿的神经发育预后。

Objective To investigate the neurodevelopmental outcome of preterm infants who were discharged from neonatal intensive care unit （NICU） at 1 year of age and the impact factors contributing to the neurodevelopmental outcome and to study whether early intervention can improve the neurodevelopmental outcome in preterm infants. Methods Early intervention guidance and follow-up visits were performed after the preterm infants discharged from NICU. The infants received the infant development test of Child Development Centre of China （ CDCC ） for neurological development at 1 year of age. The neurodevelopmental outcome was evaluated based on mental development index （MDI） and physical development index （PDI）. MDI and PDI 〉 85 was defined as normal, MDI or PDI between 70 and 85 as critical and MDI or PDI 〈 70 as abnormal. Social-domestic and clinical factors related to neurological development were analyzed by ANOVA or chi-square test. Potential high risk factors were analyzed with logistic regression. To investigate the effects of intervention compliance on neurological development, the infants were classified into two groups according to different intervention compliances. The good compliance group included infants who received a through familial intervention for more than 4 days weekly （30 minutes daily） and consulted with physicians more than 5 times in 1 year. The infants who did not receive the interventions as the good compliance group served as the bad compliance group. Results This study consisted of 210 infants, with a mean gestational age of 33.2 ± 2.6 weeks and a mean birth weight of 1 923.3 ± 558.8 g. Normal, critical and abnormal neurological development occurred in 123 cases （ 58.6% ） , 61 cases （ 29.0% ） and 26 cases （ 12.4% ） respectively. Eighteen infants （8.6%） had mental lag and 9 （4.3%） had cerebral palsy （CP）. The MDI and PDI scores of the good compliance group （111 cases） were 97.15 ± 17.38 and 94.23 ± 18.55 respectively, which were markedly higher than those of the bad compliance group （ 89.87 ± 18.92 and 87.20 ± 19.12 ; P 〈 0.05 ）. The incidence of CP （3/111, 2.7% ） in the good compliance group was lower than that of the bad compliance group （5/99, 6. 1% ） although there were no statistical differences. Parents＇ education level, multiple birth, serious intracranial hemorrhage and apnea were risk factors for adverse neurodevelopmental outcome. Conclusions Preterm infants discharged from NICU are a high risk group of neurodevelopmental disablement. Early intervention can improve the neurodevelopmental outcome of perterm infants at high risk.