高龄产妇的晚期早产儿早期体格和神经发育分析

Analysis of early physical and neurological development of late preterm infants with advanced maternal age

目的:探讨高龄产妇的晚期早产儿早期体格和神经发育情况及其影响因素。方法:选取2018年4月—2019年5月在武汉市出生并在武汉大学人民医院儿童保健门诊定期体检的105例高龄产妇的晚期早产儿为观察组,同时期选取105例高龄产妇的足月儿为对照组,回顾性收集两组婴儿的体检资料,分别比较两组婴儿在(矫正)40周龄及3、6、12月龄时的体格和神经发育情况,并分析晚期早产儿神经发育落后的危险因素。结果:观察组在矫正3、6月龄的头围、身长和体质量落后于对照组,在矫正12月龄时,仅身长处于落后状态,差异具统计学意义(P<0.05)。与对照组相比,观察组矫正40周龄的新生儿神经行为测定(NBNA)评分无统计学差异(P>0.05);矫正3月龄的粗大运动和发育商落后;矫正6月龄的粗大运动、精细运动、语言能力和发育商落后;矫正12月龄的精细运动、语言能力和发育商落后,差异具有统计学意义(P<0.05)。结论:高龄产妇的晚期早产儿早期体格发育和整体神经发育水平落后于足月儿,且低出生体质量、生后合并感染、呼吸窘迫综合征及孕母妊娠期高血压疾病、产前使用类固醇是其神经心理发育异常的危险因素。

Objective: To explore the early physical and neurological development and its influencing factors of late preterm infants with advanced maternal age.Methods: A total of 105 late premature infants with advanced maternal age born in Wuhan from April 2018 to May 2019, and receiving physical examination in Child Health Clinic of Renmin Hospital of Wuhan University, were selected as the observation group;and 105 full-term infants with advanced maternal age were selected as control group.The physical examination data of two groups of infants were collected retrospectively, and the physical and neurological development of two groups of infants at normalized age of 40 weeks, 3 months, 6 months and 12 months were compared respectively, and the risk of neural development of premature infants with advanced age was analyzed.Results: The head circumference, body length, and body mass of the observation group lagged behind those of the control group at the age of 3 and 6 months,and only the body length was in a backward state at the age of 12 months, with statistical significance(P<0. 05). Compared with that in control group, there was no significant difference in NBNA scores of 40-week-old newborns in the observation group(P>0. 05). At the age of 3 months, gross motor and developmental quotient of the observation group lagged behind that of the control group;at the age of 6 months, gross motor, fine motor, language ability, and developmental quotient of the observation group lagged behind that of the control group;and at the age of 12 months, fine motor, language ability and developmental quotient of the observation group were in a backward state, and all the differences were statistically significant(all P<0. 05).Conclusion: Early physical development and overall neurological development of late premature infants with advanced maternal age lag behind as com-pared with those of full-term infants, and low birth weight, post-natal infection, respiratory distress syndrome, hypertensive disorder complicating pregnancy, and prenatal steroid use are the risk factors of abnormal neuropsychological development.