早期综合干预对新生儿高胆红素血症智能的影响

Effects of early integrated intervention on intelligence of infants with hyperbilirubinemia.

【目的】探索早期综合干预对新生儿高胆红素血症(以下简称高胆儿)智能的影响,为制订更有效的高胆儿的随访干预措施提供理论依据。【方法】将高胆儿(均没有合并核黄疸)随机分为干预组及对照组,同时随机选取正常对照组进行随访。干预组出生后即从产科和新生儿科开始建立专科档案,进行规范管理和早期综合干预。各组均在1岁时用Gesell婴幼儿发育量表进行智能监测。【结果】①1岁时高胆对照组5个能区和平均发育商(develop-mental quotient,DQ)均低于正常对照组,差异有非常显著性(P<0.01);②高胆干预组的5个能区和平均DQ均高于高胆对照组,差异有非常显著性(P<0.05);③高胆干预组的精细动作和适应行为DQ均比正常对照组儿童低,差异有显著性(P<0.05);大运动、语言、个人社交和平均DQ两组差异无显著性(P>0.05)。【结论】高危儿规范管理和早期综合干预能促进高胆儿的智能发育,到1岁可赶上正常儿童,尤其在大运动、语言和个人社交方面,今后干预的重点是精细动作和适应行为。

[Objective] To provide academic foundation for making more efficient intervention measure, and to investigate the effects of early integrated intervention on intelligence of infants with hyperbilirubinemia. [Methods] The infants with hyperbilirubinemia without kernicterus from 2006 to 2008 in our hospital were chosen by random as the hyperbilirubinemia intervention group（n= 62） and the hyperbilirubinemia control group （n=173）, at the same time the normal children had health examined in department of child health care of our hospital as normal control group （n=485）. The hyperbilirubinemia intervention group was set up specialistic files by ohstetrician and neonatologist when they were born and received early integrated intervention and standardized management. All the babies were measured using Gesell Developmental Scale when they were one year old. [Results] ①At the age of one year, the all developmental quotient （DQ） of the hyperbilirubinemia control group was significantly higher than that of the normal control group（P〈0.05）. ②The all DQ of the hyperbilirubinemia intervention group was significantly higher than that of the hyperbilirubinemia control group （P〈0. 05）. ③The DQ of large movement, language,social skills and average had no significant difference between hyperbilirubinemia intervention group and normal control group（P〉0.05）. The DQ of fine motor and adaptive behavior of hyperbilirubinemia intervention group was significantly lower than that of the normal control group （P〈0.05）. [Conclusion] The standardize management and early integrated intervention can improve the intelligence development of infants with hyperbilirubinemia. Infants with hyperbilirubinemia can catch up with normal infants when they were one year old, especially in large movement, language and social skills. Fine motor and adaptive behavior of infants with hyperbilirubinemia should be paid much attention in future work.