出生胎龄与小于胎龄儿智能发育的相关性分析

Analysis on the correlation between gestational age and intellectual development of small for gestational age infants

目的 分析出生胎龄与小于胎龄儿(SGA)智能发育的相关性,为SGA的管理和早期干预提供参考。方法 采用回顾性病例对照方式将纳入研究的SGA按出生胎龄分为早期早产儿(<32周)、中期早产儿(32~33^+6周)、晚期早产儿(34~36^+6周)、早期儿(37~38^+6周)和足月儿(≥39周)5个组,应用0~6岁小儿神经心理发育量表对纳入研究的SGA进行智能发育评估。组间比较采用方差分析、Kruskal-Wallis检验、卡方检验和Fisher精确检验,胎龄与智能发育水平的相关性采用多元回归模型、曲线拟合以及阈值效应分析。结果 本研究共纳入研究对象203例。调整了可能的混杂因素后,早期儿组SGA较早期早产儿组SGA发育商得分高23.06分(95%置信区间[confidence interval,CI],12.58-33.55;P<0.01),较中期早产儿组SGA高7.03分(95%CI:0.74-13.32;P<0.05),较晚期早产儿组SGA高5.2分(95%CI:0.91-9.49;P<0.05),较足月儿组SGA高6.08分(95%CI:1.19-10.98;P<0.05)。阈值效应分析发现出生胎龄的关键时间点为37周,当出生胎龄<37周时,胎龄每增加1周SGA的发育商得分提高2.29分(95%CI:1.07-3.52,P<0.01);当出生胎龄>37周时,胎龄每增加1周SGA的发育商得分降低2.14分(95%CI:0.11-4.17,P<0.05)。结论 SGA智能发育水平与出生胎龄呈"U"型相关,在SGA的随访管理中应当将早产和足月SGA作为重点监测人群。

Objective To analyze the correlation between gestational age and intellectual development of small for gestational age(SGA)infants,provide a reference for management and early intervention of SGA infants.Methods A retrospective case-control study was conducted.SGA infants were divided into early premature infant group(<32 week),middle premature infant group(32-33^+6 week),late premature infant group(34-36^+6 week),early term infant group(37-38^+6 week),and full-term infant group(≥39 week)according to gestational age.Intellectual development of SGA infants was evaluated using Neuropsychology Developmental Scale for Children Aged 0-6 Years Old.The results were compared by analysis of variance,Kruskal-Wallis test,chi-square test,and Fisher exact test.The correlation between gestational age and intellectual development was analyzed using multiple regression model,curve fitting,and threshold effect analysis.Results A total of 203 infants were enrolled.After adjustment for possible confounding factors,the development quotient score of SGA infants in early term infant group was higher than that in early premature infant group by 23.06(95%CI:12.58-33.55,P<0.01),middle premature infant group by 7.03(95%CI:0.74-13.32,P<0.05),late premature infant group by 5.2(95%CI:0.91-9.49,P<0.05),full-term infant group by 6.08(95%CI:1.19-10.98,P<0.05).Threshold effect analysis found that the key time point of gestational age was 37 week.When gestational age was less than 37 week,gestational age increased by one week,the development quotient score of SGA increased by 2.29(95%CI:1.07-3.52,P<0.01);when gestational age was more than 37 week,gestational age increased by one week,the development quotient score of SGA decreased by 2.14(95%CI:0.11-4.17,P<0.05).Conclusion The intellectual development of SGA infants is correlated with gestational age,showing a"U"type,premature and full-term SGA infants should be paid more attention to in follow-up and management of SGA infants.