20项新生儿行为神经测定评分法对早产儿脑发育及脑损伤的评价

Assessment of brain development and brain injury of preterm infants by neonatal behavioral neurological assessment

【目的】探讨20项新生儿行为神经测定(neonatal behavioral neurological assessment,NBNA)评分法对早产儿脑发育及脑损伤的诊断价值。【方法】将234例不同胎龄早产儿分为高危脑损伤组(A组),共157例;"正常"早产儿组(B组),共77例。在生后3、7、14、28d进行NBNA评分。【结果】A组在生后4个时间点的NBNA评分低于B组,在28d时(校正胎龄达足月)的评分均小于36分;B组大于36分,其34、35、36周胎龄组大于37分。随评分日龄增长,两组NBNA评分均逐渐增加。其中A组35、36周胎龄组在生后14与28d间评分比较,差异无统计学意义(P>0.05),其它各胎龄组内任意两个时间点间的评分比较,差异均有统计学意义(P<0.05)。B组各胎龄组内任意两个时间点间的评分差异均有统计学意义(P<0.01),其增幅为33周>34周>35周>36周,呈减速增长。【结论】NBNA评分可以反映33周以上早产儿脑发育的状况和发展规律,及其脑损伤后的变化。

[Objective] To evaluate neonatal behavioral neurological assessment （NBNA） as a method for the assessment of brain development and brain injury of preterm infants. [Methods] 234 different gestational age hospitalized preterm infants were were divided into two groups： high risk of brain injury group（group A, n= 157） and ＂normal＂ preterm infant gruop （group B, n=77）. The two groups were assessed by NBNA at 3 days [2 to 4 days, mean（3.00±0.35）days], 7 daysE6 to 10 days, mean（7.56±0.89）days], 14 days [12 to 15days, mean（13.62±0.76）days], and 28 days [26 to 28 days, mean（27±0.32）days]after birth. [Results] The NBNA score of group A was lower than that in group B at the age of 3, 7, 14, 28 days in different GA groups. In the groups A, the NBNA score at the age of 28 days（correct GA to term）were lower than 36 points; in the groups B, which were all higher than 36 points, and higher than 37 points in 34, 35, 36 weeks＇ GA group. With the rising of the time of assessment, the NBNA score in different GA groups increased gradually. There was a significant difference between any two detected points （P〈0.05）, except those points between 14 days to 28 days in 35, 36 weeks＇ GA group of group A （P〉0.05）. There was a significant difference between any two detected points（P〈0.05） in group B. The amplification from 3 days to 28 days is 33 weeks〉34 weeks〉35weeks〉36weeks. [Conclusion] NBNA is possibly useful for the evaluation of brain development, brain injury of premature infants in 33 to 36 weekrs GA groups.