超低和极低出生体重儿神经发育结局及影响因素分析

Neurodevelopmental outcomes of extremely low birth weight and very low birth weight infants and related influencing factors

目的评估超低/极低出生体重儿(ELBWI和VLBWI)在纠正年龄(CA)18月时神经发育结局,探讨影响神经发育结局的因素。方法收集2013年1月至2014年6月入住新生儿重症监护病房并存活出院的ELBWI和VLBWI病例,在CA40周、1、3、6、12、18月定期随访,评估神经发育结局。按神经发育状况分为神经发育正常组和神经发育异常组,比较两组临床资料的差异,分析ELBWI和VLBWI神经发育的危险因素。结果共338例ELBWI和VLBWI纳入研究,15例在住院期间死亡。CA18月时,145例(44.9%)存活且随访资料完整,75例(23.2%)死亡,失访103例(31.9%)。CA18月时,145例患儿中神经发育损伤71例(49.0%),3例(2.1%)脑性瘫痪;未发现单眼或双眼失明的视觉损伤及需要助听器的听觉损伤。Logistic回归分析发现BPD和败血症是ELBWI和VLBWI神经发育异常的独立危险因素(OR=3.530,P<0.001;OR=2.528,P=0.035),BPD发生程度越重,神经发育异常的发生率越高。结论败血症、BPD(尤其是重度BPD)是ELBWI和VLBWI神经发育异常的危险因素。

Objective To investigate the neurodevelopmental outcomes of extremely low birth weight（ELBW） and very low birth weight（VLBW） infants at a corrected age（CA） of 18 months and related factors influencing the outcomes.Methods The ELBW and VLBW infants who were admitted to the neonatal intensive care unit,survived,and discharged between January 2013 June 2014 were enrolled.These infants were followed up at CAs of 40 weeks and 1,3,6,12,and 18 months to evaluate the neurodevelopmental outcomes.According to the neurodevelopmental status,the infants were divided into normal and abnormal neurodevelopment groups.The differences in clinical data were compared,and the risk factors for abnormal neurodevelopment in ELBW and VLBW infants were analyzed.Results A total of 338 ELBW and VLBW infants were enrolled,and 15 died during hospitalization.At the CA of 18 months,145 infants（44.9%） survived and had complete follow-up data,75（23.2%） died,and 103（31.9%） were lost to follow-up.Of the 145 infants who survived and had complete follow-up data,71（49.0%） had neurodevelopmental impairment（NDI）,and 3（2.1%） had cerebral palsy.No infants experienced visual damage with blindness in one or both eyes or hearing loss with a need for hearing aid.The logistic regression analysis showed that bronchopulmonary dysplasia（BDP）（OR=3.530,P〈0.001） and sepsis（OR=2.528,P=0.035） were independent risk factors for NDI in ELBW and VLBW infants,and the incidence of NDI increased with the severity of BDP.Conclusions Sepsis and BPD,especially severe BPD,are risk factors for NDI in ELBW and VLBW infants.