新型随访模式下早干预对早产儿神经发育的影响

Influences of early intervention with new follow-up pattern on the neurodevelopment of preterm infants

目的探讨新型随访模式下早干预对早产儿神经发育的影响。方法选择2014年1月至2015年6月,于钦州市妇幼保健院新生儿科经治疗存活出院,并且按约定到本院随访的408例早产儿为研究对象。采用随机数字表法,将其分为观察组(n=197)与对照组(n=211)。对观察组早产儿,采用门诊随访+现场评估及指导+电话、微信或QQ随访的新型随访模式;而对照组仅采用门诊随访+现场评估及指导的传统随访模式进行早产儿神经发育研究。随访内容主要包括对纳入研究早产儿的体格生长监测及神经发育评估等。早干预内容主要包括对早产儿的营养管理,喂养指导,神经运动训练及家属社会心理支持等。对2组早产儿校正胎龄为40周时的行为神经测查(NBNA)评分结果,以及校正月龄为6个月、12个月时的《Gesell发育量表》评估结果,采用t检验或χ~2检验进行统计学比较。本研究经钦州市妇幼保健院医学伦理委员会审核批准,并征得纳入研究早产儿家属的知情同意。结果 (1)2组早产儿校正胎龄为40周时,NBNA评分异常率及NBNA评分值比较,差异均无统计学意义(P>0.05)。(2)观察组早产儿校正月龄为6个月时,《Gesell发育量表》大运动行为,精细动作行为,语言行为,适应行为及个人社交行为5项能区异常率(11.7%、10.2%、4.1%、8.6%、6.6%)均低于对照组(20.9%、17.5%、9.5%、15.2%、13.3%),而5项能区发育商(DQ)值[(90.5±8.0)、(90.8±8.6)、(89.5±9.5)、(90.0±9.6)、(89.4±8.8)]均高于对照组[(88.0±9.5)、(88.2±8.3)、(87.4±8.1)、(87.9±9.1)、(87.5±8.2)],并且差异均有统计学意义(χ~2=6.253、4.621、4.678、4.119、5.016,t=2.686、3.037、2.375、2.298、2.240;均为P<0.05)。(3)观察组早产儿校正月龄为12个月时,《Gesell发育量表》大运动行为,精细动作行为,语言行为,适应行为及个人社交行为5项能区异常率(4.6%、4.1%、3.0%、5.1%、3.0%)均低于对照组(10.4%、10.0%、8.5%、10.4%、8.5%),5项能区DQ值[(91.3±6.8)、(91.7±7.6)、(89.5±9.4)、(90.5±9.0)、(91.3±7.7)]均高于对照组[(89.5±7.9)、(89.2±7.3)、(87.5±8.0)、(88.4±8.5)、(89.0±7.1)],并且差异均有统计学意义(χ~2=4.980、5.356、5.537、4.035、5.537,t=2.405、3.459、2.356、2.432、3.053;均为P<0.05)。结论新型随访模式下的早干预措施,更有助于早产儿的早期神经心理发育。

Objective To investigate the influence of early intervention with new follow-up pattern on the neurodevelopment of preterm infants.Methods From January 2014 to June 2015,a total of 408 preterm infants who were alive and discharged from department of Neonatology,Qinzhou Maternal and Child Health Care Hospital and regularly followed up at the outpatient service,were selected as research subjects.They were randomly divided into observation group（n=197）and control group（n=211）with the random digits table method.Infants in observation group were received a new follow-up pattern,including outpatient follow-up,onsite assessment and guidance,and telephone,WeChat or QQ,while infants in control group were received traditional follow-up pattern,including outpatient follow-up,and onsite assessment and guidance for the studies of neural development of infants.Physical growth monitoring and neurodevelopmental assessment were the main aspects of the follow-up.Early intervention mainly included infants nutrition management,feeding guidance,neuromuscular exercise training and social psychological support for family members,etc..Neonatal behavioral neurological assessment（NBNA）score at 40 weeks of corrected age,and assessment results of Gesell Developmental Scale at 6 months and 12 months of corrected age were compared between two groups of infants by t test or chi-square test.This study was approved by the Medical Ethics Committee of Qinzhou Maternal and Child Heath Care Hospital and obtained the informed consents from infants′family members.Results（1）There were no significant differences between two groups of infants at 40 weeks of corrected age in NBNA score abnormal rate and NBNA score value（P〈0.05）.（2）Gesell Developmental Scale assessment results of infants at 6 months of corrected age showed as follows.The abnormal rates of 5 Gesell subscales including gross motor behavior,fine motor behavior,language behavior,adaptive behavior and personal social behavior of infants in observation group（11.7%,10.2%,4.1%,8.6%,6.6%）were all lower than those in control group（20.9%,17.5%,9.5%,15.2%,13.3%）;the development quotient（DQ）values of5 Gesell subscales of infants in observation group [（90.5±8.0）,（90.8±8.6）,（89.5±9.5）,（90.0±9.6）,（89.4±8.8）]were all higher than those in control group [（88.0±9.5）,（88.2±8.3）,（87.4±8.1）,（87.9±9.1）,（87.5±8.2）];and all the differences above were statistically significant（χ2=6.253,4.621,4.678,4.119,5.016;t=2.686,3.037,2.375,2.298,2.240;all P〈0.05）.（3）Gesell Developmental Scale assessment results of infants at 12 months of corrected age showed as follows.The abnormal rates of 5 Gesell subscales including gross motor behavior,fine motor behavior,language behavior,adaptive behavior and personal social behavior of infants in observation group（4.6%,4.1%,3.0%,5.1%,3.0%）were all lower than those in control group（10.4%,10.0%,8.5%,10.4%,8.5%）;the DQ values of 5 Gesell subscales of infants in observation group[（91.3±6.8）,（91.7±7.6）,（89.5±9.4）,（90.5±9.0）,（91.3±7.7）]were all higher than those in control group [（89.5±7.9）,（89.2±7.3）,（87.5±8.0）,（88.4±8.5）,（89.0±7.1）];and all the differences above were statistically significant（χ~2=4.980,5.356,5.537,4.035,5.537;t=2.405,3.459,2.356,2.432,3.053;all P〈0.05）.Conclusion Early intervention with new follow-up pattern was more conduce to the early neurodevelopment of preterm infants.