早产儿新生期反复操作性疼痛与幼儿行为发育的关系

Relation of neonatal repetitive procedural pain to behavioral development in preterm toddlers

目的观察出生时有过反复操作性疼痛的早产儿在幼儿时期的行为发育情况,以及与父母养育环境的关系,分析新生儿期疼痛对机体产生的远期影响。方法选取出生后在南京医科大学附属儿童医院NICU住院的早产儿25例为早产儿组;选取同时期出生的足月健康儿童38例为足月儿组。于2岁时进行随访:父母填写自制问卷,包括一般情况,简式育儿压力量表和2~3岁儿童行为量表;同时对幼儿进行体格测量,Gesell智能发育检查。同时查阅早产儿组在NICU住院期间的病例资料,特别是致痛性操作的次数和类型,与幼儿期的行为发育相关性分析。结果早产儿组Gesell发育评估的五个能区的发育商数(DQ)均明显低于足月儿组(P<0.05),并与NICU住院期间疼痛刺激次数,母亲育儿压力呈负相关,与母亲受教育时间呈正相关(P<0.05)。同时,早产儿组内向性行为的总分以及社交退缩和抑郁子项目的得分均明显高于足月儿组(P<0.05),与母亲的育儿压力呈正相关(P<0.05)。结论出生后经历NICU住院的早产儿在幼儿期比同期足月儿的认知水平降低,内向性行为增加;其中,认知水平的改变与早期经历的反复针刺性疼痛呈负相关。而母亲的育儿压力增加会加重不良结局。

Objective In order to analyse the long-term effects of neonatal pain,and to observe the behavioral development of toddlers with repetitive procedaral pain experience in NICU during preterm infancy,as well as the relation to parenting environment,and to clarify long-term effects of neonatal pain on physical health. Methods A total of 25 preterm neonates admitted to NICU in Children＇s Hospital of Nanjing Medical University after birth were selected as preterm group （n=25）.Thirty-eight term neonates healthly born at the same period and without hospitalization experience were selected as full-term group.When follow-up at 2 years postconception age （PCA）,the parents filled in the questionnaire including general characteristics of children and parents,Parenting Stress Index-short form （PSI） and Child Behavior Check List （CBCL）;At the same time,the toddlers underwent physical examination and Gesell Development Schedule （GDS）. Results The development quotients （DQ） of GDS significantly decreased in preterm group compared to full-term group at 2 years PCA （P〈0.05）.Poor cognitive development of preterm group was related to the increased NICU skin-breaking procedures （P〈0.05） and their mother＇s PSI score （P〈0.05）,as well as low education of mother （P〈0.05）.The internalizing behavior score manifested by withdrawn behaviors and depression significantly increased in preterm group,compared with full-term group at 2 years PCA （P〈0.05）.The higher internalizing behavior in Preterm Group was positively correlated with high PSI of their mother （P〈0.05）. Conclusions Compared with full-term counterparts,the preterm born toddlers have poorer cognitive development and increased internalizing behaviors at 2 years PCA.The poorer cognitive outcome in preterm born toddlers are related to the higher number of skin-breaking procedures experienced during NICU hospitalization.What＇s more,more parenting stress from mother will worsen the Results .