超早产儿纠正6月龄内体格和神经发育结局随访研究

Follow⁃up study on physical and neurodevelopmental outcomes in extremely preterm infants at corrected age of 6 months

目的了解超早产儿纠正6月龄内的体格和神经系统预后情况,为家长和医师的救治提供依据和参考。方法回顾性分析我院2015⁃2019年间存活出院的超早产儿纠正6月龄内的随访资料。结果(1)我院救治存活至出院的超早产儿(extreme preterm infants,EPIs)共63例,失访11例,纳入本研究者共52例,出生胎龄(26.85±0.76)周,出生体重(952.25±123.04)g。(2)出院时、纠正胎龄40周和纠正6月龄时体重宫外生长迟缓(extrauterine growth retardation,EUGR)的发生率分别为75.00%、38.46%、23.07%,头围EUGR的发生率分别为78.84%、23.08%、25.64%,身长EUGR的发生率分别为76.92%、40.38%、12.82%。(3)纠正3~6月龄时婴儿神经系统国际测量量表(infant neurological international battery,Infanib)测评结果过渡51.28%,正常48.72%。(4)纠正6月龄时Gesell发育量表结果提示大运动、精细运动、适应性、语言及个人社交发育商(DQ)轻中度落后的比例分别为32.43%、10.81%、32.43%、10.81%、13.51%;五个功能区均>75分21例(56.75%)。(5)纠正6月龄时Bayley发育量表结果:单纯MDI<70分者1例(2.70%),单纯PDI<70分者3例(8.11%),MDI及PDI均<70分者1例(2.70%),均≥80分19例(51.35%)。MDI或PDI评分<80分与住院时间长、合并坏死性小肠结肠炎相关(necrotizing enterocolitis,NEC)相关。(6)未发现失明和耳聋的发生。结论纠正6月龄时40%~50%超早产儿神经系统评估处于轻度异常至临界状态,针对这部分孩子需进一步加强规范化的随访和神经系统早期干预,以期减少神经系统不良预后的发生。

Objective To investigate the physical and neurological prognosis of extremely preterm infants(EPIs)at corrected age of 6 months in order to provide basis for parents and doctors to make treatment decisions.Methods Retrospectively,the follow⁃up data of EPIs who survived and discharged from our hospital from 2015 to 2019 within corrected age of 6 months were analyzed.Results(1)Totally,63 EPIs survived and discharged in our hospital,11 out of follow⁃ups after discharge,and then 52 included in this study.The gestational age at birth was 26.18 to 27.55 weeks,and the birth weight 840 to 1040 g.(2)The incidence of extrauterine growth retardation(EUGR)in weight was 75.00%,38.46%,23.07%the incidence of EUGR in head circumference was 78.84%,23.08%,25.64%,and the incidence of EUGR in body length was 76.92%,40.38%,12.82%at discharge,the corrected gestational age of 40 weeks and corrected age of 6 months,respectively.(3)By Infant Neurological Inter⁃national Battery(Infanib),transition 51.28%of them were scored between 49~65,a medium level and 48.72%higher than 66,a normal level,at the corrected age of 3~6 months.(4)By Gesell Development Scale the propor⁃tion of mild to moderate abnormal development quotient(DQ)of gross motor movement,fine movement,adaptabil⁃ity,language and personal social contact at the corrected age of 3~6 months were 32.43%,10.81%,32.43%,10.81%,13.51%,respectively;Among them,21(56.75%)were scored>75 in the five functional areas.(5)By Bayley Development Scale at the corrected age of 6 months,1 case(2.70%)was scored<70 for MDI,3 cases(8.11%)<70 in PDI,1 case(2.70%)<70 in MDI and PDI,and 19 cases(51.35%)≥80 in both MDI and PDI.MDI or PDI with the score<80 was associated with long hospital stay and necrotizing enterocolitis(NEC).(6)No blindness or deafness was found.Conclusion At the corrected age of 6 months,40%~50%of the premature in⁃fants are in a mild abnormal state neurologically.Further standardized follow⁃up and early neurological intervention are needed for these children in order to reduce the occurrence of adverse neurological prognosis.