晚期早产儿脑白质损伤后神经系统发育障碍影响因素分析

Analysis of the influencing factors of neurodevelopmental disorder after brain white matter injury in late preterm infants

目的结合晚期早产儿脑白质损伤早期磁共振表现及其临床特点,评估其智力发育及心理运动发育,讨论不同程度脑白质损伤对晚期早产儿神经系统发育造成的影响。方法2013年2月15日至2018年3月12日沈阳市妇婴医院新生儿科收治住院并于生后8~14 d内行头MRI检查诊断为脑白质损伤的139例晚期早产儿,在患儿1周岁时成功随访其中的114例,采用智力发育指数(MDI)和心理运动发育指数(PDI)对患儿神经系统发育进行评估。结果114例晚期早产儿中,智力发育障碍和心理运动发育障碍的晚期早产儿平均胎龄、出生体质量和1 min Apgar评分均显著小于智力和心理运动发育正常的晚期早产儿,而平均需要低流量吸氧时间显著延长,差异均有统计学意义(P<0.05)。脑白质损伤程度越严重、脑室扩大程度越广,越容易导致患儿智力和心理运动发育障碍(P<0.05)。结论晚期早产儿脑白质损伤及脑室扩大越严重,其神经系统发育预后越差。

Objective Based on the magnetic resonance manifestations and clinical characteristics of brain white matter injury in late preterm infants(LPIs),to evaluate their mental development and psychomotor development,and to discuss the effects of different degrees of white matter injury on the neurological development of late preterm infants.Methods From February 15,2013 to March 12,2018,139 late preterm infants accepted MRI examination at 8-14 days after birth in Shenyang Women and Children's Hospital.Totally,114 LPIs were followed up at one year old,and their mental development index(MDI)and psychomotor development index(PDI)were measured,which were used to evaluate the neurological development of these children.Results In the 114 late preterm infants,those with mental dysfunction and psychomotor dysfunction had significantly lower average gestational age,birth body mass and l min Apgar score than the children with normal mental and psychomotor development;the time for taking low flow oxygen was significantly prolonged,and there was statistical difference(P<0.05).The more severe the brain white matter injury and the higher the degree of ventriculomegaly,the more likely the mental and psychomotor dysfunction in these children.Conclusion The more severe the brain white matter injury and the ventriculomegaly in the late preterm infants,the poorer the outcome of neurological development.The more severe the brain white matter injury and the ventriculomegaly in the late preterm infants,the poorer the outcome of neurological development.