极低和超低出生体重儿神经发育预后及其影响因素

Neurodevelopmental outcomes and its risk factors of very low and extremely low birth weight infants

目的探讨极低出生体重儿（very low birth weight infant，VLBWI）和超低出生体重儿（extremely birth weight infant，ELBWI）神经发育结局及其影响因素。方法采用回顾性分析方法。2005年10月至2009年11月，复旦大学附属儿科医院新生儿科收治并救治存活的VLBWI和ELBWI、校正胎龄18～42个月时完成贝利婴儿发育量表Ⅱ（Baley Scales of Infant DevelopmentⅡ，BayleyⅡ）测试的患儿共85例，除外在外院治疗时问较长（≥10d）的12例后，有73例患儿纳入研究。根据美国国立儿童健康与人类发育研究所对神经发育损害的定义，将73例患儿分为神经发育正常组和神经发育损害组，对可能的影响因素进行Logistic逐步回归分析。结果73例患儿平均胎龄（30．4±2．3）周，胎龄〈28周13例，～32周42例，〉32周18例。出生体重平均（1208．0±208．5）g，〈1000g15例（20．6％），～1500g58例（79．4％）。运动发育落后4例（5．5％）；发生神经发育损害者16例（21．9％），其中BayleyⅡ测试中单纯心理运动发育指数〈70分者6例（8．2％，其中1例合并脑性瘫痪），单纯智力发育指数〈70分者2例（2．7％），心理运动发育指数及智力发育指数均〈70分者7例（9．6％，其中2例合并脑性瘫痪），单纯脑性瘫痪1例（1．4％）。无一例发生单眼或双眼失明或需要助听器的听力损害。Logistic逐步回归分析提示，使用机械通气与VI。BWI和EI。BWI发生神经发育损害相关（OR=6．183．95％CI：1．664～22．983,P=0．003）。使用机械通气的患儿（n=27）心理运动发育指数为（77．5±15．1）分．明显低于未使用机械通气的患儿[n=46，（87．3±15．1）分]，差异有统计学意义（t=2．646，P=0．010）。结论VLBWI和ELBWI发生神经发育损害的比例较高，尤其是使用机械通气的患儿。

Objective To investigate the neurodevelopmental outcomes and its risk factors of very low birth weight infant （VLBWI） and extremely low birth weight infants （ELBWI）. Methods Data of 85 VLBWI and ELBWI hospitalized in Childrents Hospital of Fudan University from October 2005 to November 2009 who had finished infant development test of Baley Scales of Infant Development Ⅱ （Bayley Ⅱ ） for neurological development at corrected gestational age between 18 to 42 months were retrospectively reviewed. Twelve infants who accepted treatment in other hospital over 10 days were excluded; the rest 73 infants were divided into normal （neurodevelopment） group or abnormal group according to the definition of neurodevelopmental impairment reported by National Institute of Child Health and Human Development （NICHD） Neonatal Network. Potential risk factors of neurodevelopmental impairment were analyzed with Logistic stepwise regression. Results The mean gestationai age of 73 infants was （30.4±2.3） weeks; among which 13 were smaller than 28 weeks, 42 between 28 and 32 weeks, and 18 older than 32 weeks. The mean birth weight was （1208. 0±208.5） g; among which 15 （20. 6%） 〈1000 g, and 58 （79.4%） were between 1000 g and 1500 g. Four babies （5.5%） were diagnosed as movement retardation, and neurodevelopmental impairment occurred in 16 cases （21.9% ）,psychomotor developmental index 〈C70 occurred in 6 cases （8.2%, one case complicating with cerebral palsy）; mental developmental index 〈70 occurred in 2 cases （2.7%）; both psychomotor developmental index and mental developmental index 〈 70 occurred in 7 cases （9.6%, two cases complicating with cerebral palsy）, and one case （1.4%） was cerebral palsy only. Blind in either eyes and hearing impairment requiring deaf-aid were not found in any of the 73 babies. Logistic stepwise regression showed that use of mechanical ventilation was related to neurodevelopmental impairment （OR=6. 183, 95% CI： 1. 664-22. 983, P = 0. 003 ）. Psychomotor developmental index of infants who needed mechanical ventilation （77.5 ± 15.1） was lower than that of infants did not need （87.3±15.1）t=2. 646, P=0. 010）. Conclusions VLBWI and ELBWI are in high risk of neurodevelopmental impairment, especially those who need mechanical ventilation.