影响足月小样儿神经行为发育的围生期因素分析

Perinatal risk factors associated with neurobehavioral development of full-term small for gestational age newborn infants

目的探讨影响足月小样儿神经行为发育的围生期相关危险因素。方法收集2008年4月至2010年4月于烟台毓璜顶医院产科分娩的111例足月小样儿的围生期相关资料，采用新生儿20项行为神经测定法（neonatal behavioral neurological assessment，NBNA）于生后3～7d对其进行评估，采用单因素及多因素Logistic回归分析考察影响足月小样儿神经行为发育的围生期危险因素。结果足月小样儿行为能力、被动肌张力、主动肌张力及NBNA总分（分别为10．72±1．41，7．13±0．96，7．32±0，74，37．16±1．32）低于正常新生儿（分别为11．27±1．04，7．89±0．72，7．62±0．64，39．12±0．76），差异有统计学意义（P〈0．05）。单因素Logistic回归分析提示影响足月小样儿神经行为的因素有分娩方式、胎盘异常、脐带异常、母亲围生期感染、妊娠高血压综合征、双胎妊娠、新生儿期高胆红素血症共7个因素。多因素Logistic回归分析提示母亲围生期感染（OR=2．175，95％C／1．981～2．408，P〈0．05）、双胎妊娠（OR=1．936，95％C／1．517～2．368，P〈0．05）、高胆红素血症（OR=1．518，95％C／1．072～2．149，P〈0．05）是影响足月小样儿NBNA评分的危险因素。结论足月小样儿神经行为发育较正常新生儿差，母亲围生期感染、双胎妊娠、高胆红素血症是影响足月小样儿神经行为的危险因素。

Objective To explore perinatal risk factors associated with the neurobehavioral development of small for gestational age （SGA） full-term neonates. Methods This prospective cross-sectional study included 111 full-term newborn infants from Apr 2008 to Apr 2010 born in Yan-tai Yuhuangding Hospital. Detailed clinical data in perinatal period of all subjects were recorded. Infants aged 3 - 7 days were assessed with neonatal behavioral neurological assessment （NBNA） for neurobehavioral development. Logistic regression analysis was used to explore risk factors associated with the score of NBNA. Results Significant differ- ences （ P 〈 0. 05 ） were found between full-term SGA （ 10. 72 ± 1.41,7. 13 ± 0. 96,7.32 ± 0. 74,37. 16 ± 1.32） and normal neonates （11.27 ± 1.04,7.89 ±0. 72,7.62 ±0. 64,39. 12 ±0. 76） in terms of capacity, active and passive muscle tension and NBNA score. Full-term SGA neonates had lower score than control. Univariate logistic regression showed that delivery, placenta abnormalities, umbilical cord abnormalities, infection in perinatal period, gestational hypertension, twin pregnancy, hyperbilirubinemia affected neurobehavioral development of full-term SGA infants. Multivariate logistic regression showed that mothers＇ infection in perinatal period （ OR = 2. 175,95% CI 1.981 - 2. 408, P 〈 0. 05 ）, twin pregnancy （ OR = 1. 936,95% CI 1.517 2. 368,P 〈 0. 05） and hyperbilirubinemia （OR = 1.518,95% CI 1. 072 -2. 149,P 〈 0. 05 ） were risk factors for neurobehavioral delay of full-term SGA infants. Conclusion Full-term SGA neonates showed poorer quality in neurobehavior. Risk factors associated with neurobehavior of full-term SGA infants included mothers＇ infection in perinatal period, twin pregnancy and hyperbilirubinemia.