早产儿校正18~24月龄体格生长和神经发育水平研究

Physical growth and neurodevelopment of preterm infants at the corrected age of 18-24 months

目的研究早产儿校正18~24月龄时的体格生长和神经发育水平。方法利用早产儿出院后随访系统,前瞻性收集2018年4月—2021年12月在暨南大学附属深圳市宝安区妇幼保健院定期随访的484例早产儿校正18~24月龄的体格生长数据和神经发育评估数据。219例足月儿作为对照。采用儿童神经心理行为检查量表2016版评估神经发育水平。根据胎龄分组(超早产儿组、极早产儿组、中期早产儿组、晚期早产儿组和足月儿组),比较各组体格生长和神经发育水平。结果除中期早产儿组年龄别身长Z值高于足月儿组(P=0.038),其余各早产儿组的体格生长指标与足月儿组比较差异均无统计学意义(均P>0.05)。各早产儿组总发育商(developmental quotient,DQ)均低于足月儿组(均P<0.05);除社会行为能区外,超、极早产儿组其他各能区DQ均低于足月儿组(均P<0.05);胎龄<32周早产儿全面发育迟缓发生率(16.7%)显著高于足月儿组(6.4%)(P=0.012),全面发育迟缓发生率有随着胎龄减小而升高的趋势(P=0.026)。结论早产儿校正18~24月龄时体格生长可完成追赶,但神经发育水平落后于足月儿,应特别重视胎龄<32周早产儿的神经发育监测及早期干预。

Objective To investigate the levels of physical growth and neurodevelopment in preterm infants at the corrected age of 18-24 months.Methods The physical growth data and neurodevelopment data of 484 preterm infants at corrected age of 18-24 months were prospectively collected by a post-discharge follow-up system for preterm infants.The infants were regularly followed up in Shenzhen Bao’an Maternal and Child Health Hospital Affiliated to Jinan University from April 2018 to December 2021.The neurodevelopment was evaluated by the Children Neuropsychological and Behavioral Scale-Revision 2016.A total of 219 full-term infants served as controls.The infants were divided into groups(extremely preterm,very preterm,moderate late preterm,and full-term)based on gestational age,and the groups were compared in the levels of physical growth and neurodevelopment.Results Except that the moderate preterm group had a higher length-for-age Z-score than the full-term group(P=0.038),there was no significant difference in physical growth indicators between the preterm groups and the full-term group(P>0.05).Each preterm group had a significantly lower total developmental quotient(DQ)than the full-term group(P<0.05).Except for the social behavior domain,the DQ of other domains in the extremely preterm and very preterm groups was significantly lower than that in the full-term group(P<0.05).The<32 weeks preterm group had a significantly higher incidence rate of global developmental delay than the full-term group(16.7%vs 6.4%,P=0.012),and the incidence rate of global developmental delay tended to increase with the reduction in gestational age(P=0.026).Conclusions Preterm infants can catch up with full-term infants in terms of physical growth at the corrected age of 18-24 months,but with a lower neurodevelopmental level than full-term infants.Neurodevelopment monitoring and early intervention should be taken seriously for preterm infants with a gestational age of<32 weeks.