早产儿体格生长和神经发育的早期综合干预效果评价

Effect of early comprehensive interventions on physical growth and nerve development among premature infants

目的评价早期综合干预对早产儿体格生长和神经发育的效果,为早产儿出院后随访管理提供依据。方法选择2019—2021年绍兴市妇幼保健院出生的130例早产儿,根据胎龄和出生体重分配入高危组和低危组,实施营养支持、家长喂养发育指导等早期综合干预措施至12月龄;选择同期306名正常足月新生儿作为对照,按照基本公共卫生服务项目要求开展定期健康体检。定期测量身长、体重和头围,12月龄时采用贝利婴幼儿发展量表(中国城市版)评估智力和运动发育能力。比较3组婴儿体格发育状况、智力发育指数(MDI)和运动发育指数(PDI)。结果早产儿130例,胎龄28~36周,出生体重1200~3440 g,男婴79例,其中低危早产儿组80例,高危早产儿组50例;足月儿组306人,胎龄37~42周,出生体重2500~4000 g,男婴162人。广义估计方程分析显示,3组婴儿身长(Waldχ^(2)=28.664,P<0.001)、头围(Waldχ^(2)=19.312,P=0.013)生长速度差异有统计学意义;12月龄时,3组婴儿体重(F=0.639,P=0.528)、身长(F=1.051,P=0.350)和头围(F=0.318,P=0.728)差异均无统计学意义。12月龄时高危早产儿组、低危早产儿组和足月儿组MDI异常率分别为2.00%、0%和1.31%,差异无统计学意义(χ^(2)=1.319,P=0.517);PDI异常率分别为20.00%、7.50%和5.56%,差异有统计学意义(χ^(2)=12.818,P=0.002)。结论经早期综合干预,早产儿体格生长良好,MDI与足月儿相比无明显差异,但高危早产儿PDI异常率较高。建议在早产儿管理中重点关注高危早产儿运动能力的发展。

Objective To examine the effect of early comprehensive interventions on the physical growth and nerve de⁃velopment among premature infants,so as to provide insights into the follow-up management of premature infants after discharge from hospital.Methods A total of 130 premature infants delivered in Shaoxing Municipal Maternal and Child Health Care Hospital from 2019 to 2021 were selected and divided into high-and low-risk groups according to gestational age and birth weight,while 306 full-term normal infants in the same hospital during the study period served as controls.All premature infants were given early comprehensive interventions until age of 12 months,including nutri⁃tional support and parental guidance of children's feeding and development,and all normal infants received periodical health checkup according to the basic public health service program.All infants received periodical measurements of height,weight and head circumference,and the 12-month intellectual and motor development ability was measured us⁃ing the Bayley Scales of Infant Development revised in Chinese cities was used to assess.Infants'physical growth,mental development index(MDI)and motor development index(PDI)were compared among groups.Results There were 130 premature infants with gestational ages of 28 to 36 weeks and birth weight of 1200 to 3440 g,including 79 male infants,and there were 80 infants in the low-risk group and 50 infants in the high-risk group.The full-term in⁃fants had a gestational age of 37 to 42 weeks,and birth weights of 2500 to 4000 g,including 162 male infants.There were significant differences in height(Waldχ^(2)=28.664,P<0.001)and head circumference growth(Waldχ^(2)=19.312,P=0.013)among the three groups as revealed by the generalized estimating equation;however,no significant dif⁃ferences were seen in the 12-month weight(F=0.639,P=0.528),height(F=1.051,P=0.350)or head circumference(F=0.318,P=0.728)among the three groups.The percentages of abnormal MDI were 2.00%,0 and 1.31%among the high risk premature infants,low-risk premature infants and full-term infants at ages of 12 months(χ^(2)=1.319,P=0.517),while the percentages of abnormal PDI were 20.00%,7.50%and 5.56%among the three groups at ages of 12 months(χ^(2)=12.818,P=0.002).Conclusions Following implementation of early comprehensive interventions,the premature in⁃fants have favorable physical growth and comparable MDI with full-term infants;however,a high percentage of abnor⁃mal PDI is seen in high-risk premature infants.An improvement in the motor development among high-risk premature infants is recommended to be emphasized during the management of premature infants.