早产儿出院后营养管理与神经系统发育评估方法调查分析

Analysis of evaluation method and investigation on neural development and nutrient management in preterm infants after discharge

目的了解早产儿出院后营养管理与神经系统发育评估方法使用情况。方法选取位于我国华北部3家,华东部2家,华中部2家,西南部2家,华南部4家,共13家具有代表性的医院分别于项目培训前后进行问卷调查。对所在医院负责早产儿出院后营养管理的科室、神经系统发育评估方法、推荐营养补充剂情况和血营养代谢指标筛查情况、早产儿出院后随访率以及调查前后答题得分进行分析。采用t检验进行统计学分析。结果早产儿出院后随访工作61.5%(8/13)由儿童保健科开展,新生儿科负责随诊的占38.5%(5/13)。各医院在随访中运用的神经系统评估方法包括Peabody运动发育量表占15.4%(2/13),Gesell发育诊断量表占69.2%(9/13),Bayley表占30.8%(4/13)。血营养代谢指标中13家医院均检测血红蛋白和红细胞平均体积;检测25-OH-VD、碱性磷酸酶、血钙血磷、尿素氮和前白蛋白的医院占比分别为84.6%(11/13)、76.9%(10/13)、69.2%(9/13)、46.2%(6/13)。大部分医院早产儿出院后随访率均能达到60%以上,最低随访率为30%～40%。培训后的答题得分(88±9)分,高于培训前的答题得分(80±15)分,差异有统计学意义(t=36.846,P<0.05)。结论新生儿科与儿童保健科应加强合作,共同管理早产儿出院后随访工作。神经系统评估方法有待进一步统一。在营养管理方面除了评价体格发育指标,还应合理进行血营养代谢指标筛查。

Objective To realize the usage of evaluation method on neural development and nutrient management in preterm infants after discharge. Methods A total of 13 typical hospitals were received questionnaire at pre-training and post-training, including 3 hospitals in the north of China, 2 hospitals in the east of China, 2 hospitals in the central of China, 2 hospitals in the southwest of China ,4 hospitals in the south of China. Those date were analyzed in the responsible department for nutrition management for premature infant after discharge, evaluation method of neural development, recommendation nutritional supplements and blood screening of nutrition metabolism index, the rate of premature follow-up after discharge, the rate of correct before and after the investigation. The statistical analysis was performed by t test. Results 61.5%(8/13) of follow-up work of preterm infants after discharge was carried out by child care department, newborn department in charge of that was 38.5%(5/13). Evaluation methods of neural development were applied by Peabody motor development scale 15.4%(2/13), Gesell diagnosis developmental scale 69.2%(9/13), Bayley scale 30.8%(4/13) during the follow-up for 13 hospitals. Hemoglobin and mean corpuscular volume (MCV) were all detected on blood nutrition metabolic indices in 13 hospitals. The percentage of detection in 25 - OH - VD, alkaline phosphatase, blood calcium and blood phosphorus, urea nitrogen, prealbumin were 84.6%(11/13),76.9%(10/13), 69.2%(9/13), 46.2%(6/13) respectively. The follow-up rate of most hospitals could reach more than 60% and the lowest of that was 30%-40% in preterm infants after discharge. There was statistical significance on post-training correct rate of answer, comparring with pre-training of that[(88±9) vs (80±15), t=36.846, P<0.05]. Conclusions Neonatal department and child care department should strengthen the cooperation to manage follow-up work of premature infants after discharge together. Evaluation method of neural development needs further unify. Blood screening of nutrition metabolism index should be performed reasonably in addition to evaluation physical development index in managmen of nutrition.