不同胎龄早产儿实足24月龄神经心理发育状况分析

Neurodevelopment of premature infants with different gestational ages at 24 months old

目的探讨不同胎龄早产儿实足24月龄神经心理发育现况,为改善早产儿的神经心理发育结局提供依据。方法选取实足24月龄随访早产儿159例,根据出生胎龄分为34周≤出生胎龄<37周的低危组(n=97);32周≤出生胎龄<34周的中危组(n=36);出生胎龄<32周的高危组(n=26)。收集其校正12月龄、实足24月龄采用北京首都儿童研究所0～6岁儿童神经心理发育量表测查的神经心理发育报告,并对影响神经心理发育的新生儿严重并发症等随访资料进行回顾性分析。结果高危组合并影响神经心理发育的新生儿严重并发症明显增多,例如高胆红素血症、新生儿窒息、颅内出血、呼吸窘迫综合征,差异具统计学意义(χ~2=64.94、22.88、37.08、103.48,P<0.05)。3组早产儿在校正12月龄的各能区发育商达到正常水平。实足24月龄的各能区发育商中,高危组除大运动发育商外其他能区发育商均低于正常水平,中低危组的大运动及认知能区评分达到正常水平,但其他能区发育商仍低于正常;总发育商(F=2.14)低于正常水平,3组差异无统计学意义(P>0.05)。结论不同胎龄早产儿校正12月龄神经心理有良好的追赶发育。但实足24月龄的神经心理发育评估中,高危组只有大运动能追赶至正常水平,精细运动、认知、语言、社会交往未追赶至正常水平;中、低危组的大运动和认知发育能追赶至正常水平,精细运动、语言、社交行为发育仍低于正常水平。

Objective To investigate the neurodevelopment of premature infants with different gestational ages at 24 months old.Methods A total of 159 premature infants of 24 months old were recruited.The cases were divided into low-risk group (34 weeks≤GA<37 weeks,n=97),intermediate-risk group (32 weeks≤GA<34 weeks,n=36) and high-risk (GA<32 weeks,n=26) group.Neurodevelopment was evaluated by Neuropsychological development scale for children aged 0-6 years at the corrected age of 12 months and at the actual age of 24 months.The severe neonatal complications in relation to neurodevelopment were analyzed.Results Severe neonatal complications,such as neonatal hyperbilirubinemia,neonatal asphyxia,intracranial hemorrhage and neonatal respiratory distress syndrome,were significantly increased in the high-risk group (P<0.05).Development quotients (DQ) of each area in three groups at the corrected 12 months old reached a normal level.No significant differences of average DQ were detected among the three groups (P>0.05).The multiple area DQ of the 24 months old infants in the high-risk group were at low levels,except for the motor area DQ.The motor and cognitive area DQ of the intermediaterisk group at the age of 24 months reached the normal level,but the other areas DQ were still lower than the normal level.The average DQ of 3 groups at 24 months of age (F=2.14) were lower than that of the normal level,and no significant differences were detected among 3 groups (P>0.05).Conclusion Premature infants with different gestational ages has a good catch-up growth in the neurodevelopment at the corrected age of 12 months.However,among the neurodevelopment assessment of the 24 months old infants,only motor development in the high-risk group and the motor and cognitive development in the lowand intermediate-risk groups can catch up to the normal level.