晚期早产儿神经发育预后及影响因素分析

A study on the neurological developmental outcome and associated impact factors of late preterm infants at 1 year of age

目的探讨晚期早产儿在校正年龄1岁时的神经发育情况及其影响因素。方法采用首都儿科研究所修订的《0～6岁小儿神经心理发育量表》,对2008年4月至2009年4月于本院产科分娩的晚期早产儿及足月儿在校正年龄/生后年龄满1岁时进行智能发育测试,按照发育商(DQ)将晚期早产儿分为神经行为发育异常组(DQ<85)和正常组(DQ≥85),分析可能对神经发育产生影响的社会家庭因素和临床相关因素,应用Logistic回归分析筛选影响晚期早产儿神经发育的危险因素。结果晚期早产儿组165例,校正年龄1岁时神经行为发育异常9例(5.5%),对照组102例,1岁时神经行为发育异常3例(2.9%),两组差异有统计学意义(χ2=5.047,P<0.05)。1岁时晚期早产儿DQ低于足月儿[(93.8±7.5)分比(98.8±9.8)分,P<0.05],其大运动、精细动作、语言均落后于足月儿。极低出生体重(OR=2.175)、低血糖(OR=1.924)、母亲文化程度初中以下(OR=0.602)是影响晚期早产儿神经发育预后的危险因素(P<0.05)。结论晚期早产儿是发生不良神经预后的高危人群,与极低出生体重、低血糖、母亲文化水平低密切相关。

Objective To study the neurological development of late preterm infants at 1 year old corrected age and its related factors. Methods A total of 165 late preterm infants and 102 full-term infants received assessments with ＂ 0-6-year-old children intelligence developmental scale ＂ for neurological development at 1 year of age. The neurological development outcome were estimated with developmental quotient （ DQ ）. DQ 〈 85 was defined abnormal. Social-domestic and clinical factors related to neurological development were analyzed with Logistic regression. Results Higher abnormal rate of low DQ was found among late preterm infants than normal infants （X2 = 5.047, P 〈 0. 05 ）. Comparing with the normal infants, late preterm infants had poor score in terms of DQ, especially in gross motor, exiguous action and language. Logistic regression showed very-low-birth-weight（ OR = 2. 175）, hypoglycemia （ OR = 1. 924） and education level of mother （ OR = 0. 602 ） were related to DQ scores of late preterm infants. Conclusions The late preterm infants are much more likely to suffer neurological developmental delay. It is closely related to very-low-birth-weight, hypoglycemia and education level of Mother.