极早早产儿神经发育预后随访结果及影响因素分析

Follow-up results and influencing factors of neurodevelopmental prognosis in very preterm infants(VPI)

目的分析极早早产儿(VPI)神经发育预后情况及其相关高危因素。方法对2017年1月至2019年9月期间,华中科技大学同济医学院附属同济医院新生儿科出院后的85例VPI进行随访,在纠正年龄1岁时通过智能发育测试(CDCC)评估神经发育预后情况。根据预后结果将VPI分为正常组(43例)和异常组(42例),列举可能对神经行为发育产生影响的临床相关因素和家庭因素,应用单因素及多因素Logistic回归分析VPI神经发育预后的危险因素。结果正常组VPI出生体重为(1.6±0.2)kg,高于异常组[(1.4±0.3)kg];正常组VPI住院时间为(40.8±9.2)d,低于异常组[(45.7±9.9)d];正常组颅内出血发生率为11.6%,低于异常组(33.3%);正常组超低出生体重新生儿的发生率为14.0%,低于异常组(33.3%);正常组VPI母亲的文化程度高于异常组,正常组VPI父母对早期教育重视程度高于异常组;且正常组VPI父母积极干预率为41.9%,高于异常组(14.3%);上述指标组间差异均有统计学意义。Logistic回归分析显示,母亲文化水平不高、超低出生体重和颅内出血的发生是影响VPI神经发育预后的独立危险因素,而父母对早期教育的重视及干预的积极性是保护因素。结论母亲文化水平、出生体重、颅内出血、父母对早期教育的重视程度和干预积极性与VPI神经发育预后密切相关。

Objective To analyze the neurodevelopmental prognosis and its relevant risk factors in Very Preterm Infants(VPI).MethodsFrom January 2017 to September 2019,85 cases of VPI discharged from the Department of Neonatology,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,were followed up,and their neurodevelopmental prognosis was assessed through the Intelligent Developmental Test(CDCC)at corrected age of one year.According to the prognostic results,VPIs were divided into normal group(43 cases)and abnormal group(42 cases).The clinical related factors and family factors those may have impacts on neurobehavioral development were listed.Univariate and multivariate logistic regression models were used to analyze the prognosis of VPI neurodevelopment and the risk factors.ResultsThe birth weight of VPI in the normal group was(1.6±0.2)kg,higher than that in the abnormal group(1.4±0.3)kg.The hospital stay of VPI in the normal group was(40.8±9.2)d,lower than that in the abnormal group(45.7±9.9)d;The incidence of intracranial hemorrhage in the normal group was 11.6%,lower than that in the abnormal group(33.3%).The incidence of extremely low birth weight(ELBW)in the normal group was 14.0%,lower than that in the abnormal group(33.3%).The early education attendance and maternal education level in the normal group were significantly higher than those in the abnormal group,the VPI parents in the normal group paid more attention to early education than those in the abnormal group,and the VPI parents′active intervention rate in the normal group was 41.9%,significantly higher than that in the abnormal group 14.3%.The aforementioned differences were all statistically significant.Logistic regression analysis showed that the low maternal education level,ELBW,intracranial hemorrhage were independent risk factors for the prognosis of VPI neurodevelopment,while parental attention to early education and active intervention were protective factors.ConclusionParents′education level,birth weight,intracranial hemorrhage,and parents′attention to early education and intervention enthusiasm are closely related to the prognosis of VPI neurodevelopment.