早产儿神经发育预后超早期预测指标的随访研究

Follow up study on ultra-early predictors of neurodevelopmental outcome in preterm infants

目的探讨早产儿神经发育预后的超早期预测指标。方法选取2012年1月1日至2014年5月31日在济宁医学院附属医院儿童康复科就诊的0~3月龄早产儿临床资料并完成神经发育随访的儿童共201例,分析0~3月龄早产儿围生期合并症、性别、胎龄、分娩方式、出生体重、颅脑核磁共振成像(MRI)资料、肌张力情况及头部控制能力等病例资料,应用0~6岁小儿神经心理发育检查表进行神经发育学评估,并应用Logistic回归分析探讨0~3月龄早产儿临床特征与其预后的关系。结果早产儿多合并其他围生期并发症,以低出生体重、新生儿窒息为最常见。不同预后组早产儿在性别、胎龄、分娩方式、出生体重方面差异无统计学意义(χ~2值分别为0.28、4.06、0.81、3.53,均P>0.05)。与预后良好组比较,预后不良组早产儿在肌张力、头控能力方面异常率高(χ~2值分别为9.86、43.58,均P<0.01)。早产儿的脑损伤影像学类型以脑白质损伤为主,其中脑室周围白质损伤最为常见,预后不良组早产儿颅脑MRI异常率高于预后良好组(χ~2=34.43,P<0.01)。Logistic回归分析结果提示早产儿神经发育预后的主要预测指标为颅脑MRI结果(OR=7.44,95%CI:3.46~15.99)、肌张力状况(OR=2.51,95%CI:1.22~5.17)及头控能力(OR=9.64,95%CI:4.57~20.33)。结论头控能力、颅脑MRI结果及肌张力状况可以作为早产儿神经发育预后的超早期预测指标,综合分析上述因素有利于及时确定早期干预重点人群。

Objective To explore the ultra-early predictors of neurodevelopmental outcome in preterm infants.Methods A total of 201 cases of 0-3 months old preterm infants who visited pediatric rehabilitation department of Affiliated Hospital of Jining Medical University from January 1,2012 to May 31,2014 and completed follow-up were selected.Perinatal complications,gender,gestational age,delivery mode,birth weight,brain nuclear magnetic resonance imaging（MRI）,muscular tension and head control ability of patients were analyzed.Neurodevelopmental outcomes were assessed by neuropsychological development scale for 0-6 years old children.Logistic regression analysis was applied to explore the relationship between clinical features and prognosis of preterm infants aged 0-3 months.Results Preterm infants usually had perinatal complications,in which low birth weight and neonatal asphyxia were most common.Differences in gender,gestational age,delivery mode and birth weight in preterm infants with different outcomes were not significant（χ~2 value was 0.28,4.06,0.81 and 3.53,respectively,all P〈0.05）.Abnormality rates of muscular tension and head control ability in infants with poor prognosis were higher than those in infants with good prognosis（χ~2 value was 9.86 and 43.58,respectively,both P〈0.01）.Brain MR imaging showed that lesions in white matter was major form of brain damage in preterm infants,and periventricular white matter damage was most common.Abnormality rate of MRI in infants with poor prognosis was higher than that in infants with good prognosis（χ~2=34.43,P〈0.01）.Logistic regression analysis showed that major ultra-early predictors of neurodevelopmental outcome in preterm infants were brain MRI（OR=7.44;95%CI：3.46-15.99）,muscular tension（OR=2.51;95%CI：1.22-5.17）and head control ability（OR=9.64;95%CI：4.57-20.33）.Conclusion Head control ability, brain MRI and muscular tension can be used as ultra-early predictors of neurodevelopmental outcome in preterm infants.Comprehensive analysis of the above factors is helpful for timely identification of key population of early intervention.