1042名儿童2岁时神经心理发育状况的随访研究

Follow-up study on the neuropsychological development of 1042 children at the age of 2 years old

目的 分析儿童2岁时神经心理发育状况,为促进儿童早期发育提供依据。方法 选取2017年1月-2020年5月在广州市妇女儿童医疗中心儿童早期发展门诊定期随访的1 042名儿童作为研究对象,根据其出生胎龄分为4组,即早期早产儿(28~33;周)组、晚期早产儿(34~36;周)组、早期足月儿(37~38;周)组和完全足月儿(39~41;周)组,并在其校正年龄2岁时采用Gesell发育量表进行神经心理发育评估。结果 4组儿童Gesell发育量表5个能区发育商(DQ)比较,适应性、大运动和精细运动差异均有统计学意义(F=3.152、2.821、5.256,P<0.05);组间两两比较,早期早产儿适应性、大运动、精细运动均落后于早期足月儿和完全足月儿,晚期早产儿精细运动落后于完全足月儿,差异均有统计学意义(P<0.05)。4组儿童大运动和精细运动发育异常率比较,差异有统计学意义(χ^(2)=12.440、27.128,P<0.05),且表现为完全足月儿<早期足月儿<晚期早产儿<早期早产儿。与完全足月儿相比,晚期早产儿2岁时精细运动发育落后的风险增加(OR=1.809,95%CI:1.102~2.970,P<0.05)。结论 早期早产儿和晚期早产儿在2岁时均存在不同程度的神经心理发育落后,需延长随访并加强干预。

Objective To analyze the neuropsychological development of children at the age of 2 years old,in order to provide reference for promoting the early development of children.Methods 1042 children who were regularly followed up in the Early Childhood Development Clinic of Guangzhou Women and Children's Medical Center were selected into this study,and were divided into four groups according to their gestational age,including early preterm infants(28~33^(+6) weeks),late preterm infants(34~36^(+6) weeks),early term infants(37~38^(+6) weeks),and full term infants(39~41^(+6) weeks).Gesell Development Scale was used to assess their neuropsychological development at the corrected age of 2 years old.Results There were statistically significant differences in the development quotients(DQ)of adaptability,gross motor and fine motor among the four groups(F=3.152,2.821,5.256,P<0.05).Pair comparison among groups showed that the DQ of adaptability,gross motor and fine motor of early preterm infants were lower than those of early term infants and full term infants,and late preterm infants were lower than full term infants in terms of fine motor(P<0.05).The incidence rates of neuropsychological development delay(DQ<85)in gross motor and fine motor among the four groups were significantly different(χ^(2)=12.440,27.128,P<0.05),and the risk ranged from low to high group was as follows:full term infants<early term infants<late preterm infants<early preterm infants.Compared with full term infants,late preterm infants had an increased risk of fine motor developmental delay at 2 years old(OR=1.809,95%CI:1.102-2.970,P<0.05).Conclusions Early preterm infants and late preterm infants have different degrees of neuropsychological developmental delay at the age of 2 years old.So it is necessary to extend follow-up and strengthen intervention.