晚期早产儿近期并发症及智能发育前瞻性研究

Prospective study of short-term complications and intellectual development in late preterm infants

目的前瞻性观察晚期早产儿与足月儿生后各系统近期并发症发生率及智能发育情况。方法收集2011年上海交通大学医学院附属新华医院产科出生的新生儿,将晚期早产儿（胎龄34-36周）和足月儿（胎龄37-42周）作为观察对象,记录两组新生儿出生早期各系统并发症发生情况,包括呼吸、循环、消化系统等;随机选择部分转入新生儿科的晚期早产儿,通过多种社会因素配对后,相应选择部分转入新生儿科的足月儿,两组在校正年龄6个月、1周岁及2周岁时进行智能测试,比较其各年龄段智能水平。结果研究期间共纳入晚期早产儿183例,足月儿2 144例。晚期早产儿先天畸形（14.8%比4.5%）和喂养不耐受（7.1%比0.1%）发生率均高于足月儿（P〈0.05）。转入新生儿科治疗的晚期早产儿88例,足月儿364例,住院治疗的晚期早产儿低血糖（23.9%比3.0%）、低钙血症（4.6%比0.8%）、呼吸窘迫综合征（10.2%比0）、呼吸暂停（12.5%比0）、吸入性肺炎（31.8%比6.9%）、先天性心脏病（40.9%比14.6%）、心肌损害（25.0%比11.8%）、脑室周围-脑室内出血（22.7%比3.3%）、缺氧缺血性脑病（4.6%比0.3%）及败血症（10.2%比2.2%）发生率均高于足月儿（P〈0.05）。1周岁时晚期早产儿粗、细动作落后于足月儿,2周岁时细动作、语言、应人能力落后于足月儿,差异有统计学意义（P〈0.05）。结论晚期早产儿生后近期各系统并发症发生率较高,智能发育欠佳,需加强监护并进行针对性干预。

Objective To observe the difference of incidence in short-term complications and intellectual development between late preterm and term infants. Methods All the late preterm infants（ gestational age from 34 to 36 weeks） and term infants（ gestational age from 37 to 42 weeks） born at Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine in 2011 were enrolled in this study. Short-term complications of the two groups,including respiratory,circulatory,digestive system etc.,were recorded and analyzed. In addition,among the late preterm infants enrolled in the study,29 infants admitted in the neonatal ward were randomly selected and matched with term infants（ n = 36） through pairing of multiple social factors. At the adjusted age of 6 months,1 year,and 2 years old,cognitive skills of infants of the both groups were assessed and compared. Results During the study period,183 late preterm infants and 2 144 term infants were included. The incidence of congenital malformations and feeding intolerance（ 14. 8% and 7. 1%） in late preterm infants were significantly higher than those in term infants（ 4. 5% and 0. 1%）（ P〈0. 05）. There were 88 late preterm infants and 364 term infants who were admitted in the neonatal ward after delivery. Among them,incidences of short term complications in late preterm infants compared to term infants were： hypoglycemia（ 23. 9% to3. 0%）,hypocalcemia（ 4. 6% to 0. 8%）, respiratory distress syndrome（ 10. 2% to 0）, apnea（ 12. 5% to 0）,aspiration pneumonia（ 31. 8% to 6. 9%）,congenital heart disease（ 40. 9% to14. 6%）,myocardial injury（ 25. 0% to 11. 8%）,periventricular-intraventricular hemorrhage（ 22. 7%to 3. 3%）,hypoxic-ischemic encephalopathy（ 4. 6% to 0. 3%） and sepsis（ 10. 2% to 2. 2%）; all were significantly higher in late preterm infants（ P〈0. 05）. At 1 year of age,the development of gross and fine motor skills of infants born late preterm were lagging behind their peers of term birth（ P〈0. 05）.Likewise,the development of fine motor skills, language and social skills in late preterm infants continued to lag behind term infants at the 2 years of age（ P〈0. 05）. Conclusions Late preterm infants had increased incidence of short-term complications post delivery, their short-term neurodevelopment skills were also compromised. Therefore,close observation and intensive care of late preterm infants were needed for early detection and targeted intervention of complications.