坏死性小肠结肠炎对52例早产儿神经发育的影响

Effect of necrotizing enterocolitis on neurodevelopment among 52 premature infants

目的了解坏死性小肠结肠炎(necrotizing enterocolitis,NEC)及其严重程度对早产儿远期神经发育的影响,以期为早产儿神经发育障碍的诊治提供参考。方法采用前瞻性队列研究,选取2018年1月—2021年11月收治于泉州市儿童医院的NEC早产儿52例、非NEC早产儿104例为研究对象,应用Gesell发育量表在幼儿期评估其神经发育水平,将发育商(development quotient,DQ)≤85定义为神经发育异常。分析NEC早产儿与非NEC早产儿的神经发育异常发生率以及体格发育情况等指标。结果在矫正25(20,28)月龄时,NEC组的年龄别身高Z评分低于非NEC组[−0.75(−1.58,0.03)vs.−0.17(−0.84,0.38),P=0.01],神经发育异常发生率明显高于非NEC组(67.3%vs.35.6%,P<0.001),DQ低于非NEC组[84(80,89)vs.87(82,93),P=0.01]。NEC组大运动及精细运动的评分均低于非NEC组[88(77,94)vs.92(85,96),P=0.03;89(83,96)vs.93(87,100),P=0.01]。NEC组中的外科组25例早产儿和内科组27例早产儿的体格发育比较差异无统计学意义(P>0.05),但外科组早产儿神经发育异常发生率高于内科组早产儿(88.0%vs.48.0%,P<0.05)。外科组合并短肠综合征(short bowel syndrome,SBS)的4例患儿和未合并SBS的21例患儿的体格发育和神经发育异常发生率比较差异均无统计学意义(均P>0.05),但前者的DQ低于后者[75(62,77)vs.83(81,85),P<0.05]。结论NEC早产儿出现神经发育异常的风险高于非NEC早产儿,且异常发生率较高。NEC越严重,不良神经发育结局的风险越高。

Objective To investigate the effects of necrotizing enterocolitis(NEC)and its degree of severity on long-term neurodevelopment,in order to provide evidence for early diagnosis and intervention of neurodevelopmental impairment among premature infants.Methods A prospective cohort study was conducted.52 NEC and 104 non-NEC preterm infants admitted to Quanzhou Children's Hospital were recruited as study subjects from Jan,2018 to Nov,2021.Gesell developmental scale was used to assess neurodevelopment at toddler's age.The development quotient(DQ)≤85 was defined as neurodevelopmental impairment.The incidence of neurodevelopmental abnormalities and physical development between NEC and non-NEC preterm infants were analyzed.Results At corrected age of 25(20,28)months,height-for-age Z-score in the NEC group was significantly lower than that in the non-NEC group[−0.75(−1.58,0.03)vs.−0.17(−0.84,0.38),P=0.01].The incidence of neurodevelopmental impairment in NEC group was higher than that in non-NEC group(67.3%vs.35.6%,P<0.001).The total DQ,gross motor DQ and fine motor DQ in NEC group were lower than those in non-NEC group[84(80,89)vs.87(82,93),P=0.01;88(77,94)vs.92(85,96),P=0.03;89(83,96)vs.93(87,100),P=0.01].There was no significant difference in physical development between surgical(n=25)and internal medical group(n=27)within NEC group(P>0.05),but the incidence of neurodevelopmental impairment in the surgical group was significantly higher than that in the internal medical group(88.0%vs.48.0%,P<0.05).Within the surgical group,there was no significant difference in physical development and neurodevelopmental impairment between the NEC with short bowel syndrome(SBS)group(n=4)and NEC without SBS group(n=21)(P>0.05),but the DQ in the NEC with SBS group was lower than that in NEC without SBS group[75(62,77)vs.83(81,85),P<0.05].Conclusion The risk of neurodevelopmental abnormalities is higher in NEC survivors than that in non-NEC.The higher severity degree of the NEC,the higher risk of the adverse neurodevelopmental outcomes.