早期干预对NICU早产儿体格及神经心理发育的效果研究

Effects of early intervention on physical and neuropsychological development in NICU preterm infants

目的 探讨早期干预对于新生儿重症监护病房(NICU)早产儿两年内的体格和神经心理发育的影响。方法 选取2018年1月至2020年12月于苏州市立医院就诊的102例NICU早产儿为干预组,随机抽取105例同期健康足月儿为对照组。结果 矫正24月龄时,经早期干预的低危早产儿体重、身长以及头围的Z评分均可达到正常足月儿水平(分别为0.34±0.98、0.40±1.30和0.54±1.04,P>0.05),但是高危早产儿组的3项Z评分不及足月儿组(分别为-0.17±1.15、0.00±1.29和-0.33±1.24,P<0.05)。大运动方面,矫正6~24月龄,高危、低危早产儿均可达足月儿水平,24月龄时,高危儿组、低危儿组、足月儿组分别为101.81±10.05、02.06±10.85、100.47±9.40(P>0.05)。语言与社交行为方面,矫正18~24月龄,早产儿的发育水平可达足月儿水平。适应能力发育方面,矫正18月龄前,高危、低危早产儿适应能力水平可达足月儿,但24月龄时,早产儿适应能力水平均不及足月儿,高危儿组、低危儿组、足月儿组分别为102.77±12.04、101.73±10.34、106.78±9.31(P<0.05)。与之类似的精细运动发育,矫正12月龄时,高危、低危早产儿精细运动水平可达足月儿,18~24月龄时,高危、低危早产儿精细运动水平均不及足月儿。结论 出生后2年内高危和低危早产儿体格及神经心理发育存在差异,且高危早产儿落后尤其明显。正确认识早产儿体格及神经心理发育规律,制定个体化的早期干预模式,对早产儿的体格及神经心理发育具有重要作用。

Objective To investigate the effects of early intervention on the physical and neuropsychological development of preterm infants in neonatal intensive care unit(NICU)within two years.Methods A total of 102 NICU preterm infants treated at Suzhou Municipal Hospital from January 2018 to December 2020 were selected as the intervention group,and 105 healthy full-term infants born during the same period were randomly selected as the control group.Results At 24 months of age,the Z-scores for weight,length and head circumference of low-risk preterm infants who received early intervention reached level similar to full-term infants(0.34±0.98,0.40±1.30 and 0.54±1.04,respectively,P>0.05),however,the Z-scores for these measures in the high-risk preterm infants were lower compared to the full-term group(-0.17±1.15,0.00±1.29,and-0.33±1.24,respectively,P<0.05).In terms of gross motor development,by 6 to 24 months corrected age,both high-risk and low-risk preterm infants reached levels comparable to full-term infants.At 24 months of age,the mean scores for high-risk,low-risk and full-term infants were 101.81±10.05,102.06±10.85,and 100.47±9.40,respectively(all P>0.05).In terms of language and social behavior,by 18 to 24 months corrected age,the development level of preterm infants could reach the level of full-term infants.In terms of adaptive development,before 18 months corrected age,the adaptive ability of high-risk and low-risk preterm infants could reach full-term infants,however,at 24 months,the adaptive ability of preterm infants were lower than that of full-term infants,and the adaptive ability of high-risk infants,low-risk infants and full-term infants were 102.77±12.04,101.73±10.34,106.78±9.31,respectively(all P<0.05).Similar trends were observed for fine motor development,at 12 months corrected age,the fine motor level of high-risk and low-risk preterm infants could reach full-term infants,and at 18 to 24 months corrected age,the fine motor level of high-risk and low-risk preterm infants were lower than full-term infants.Conclusion Within the first two years after birth,there are differences in physical and neuropsychological development between high-risk and low-risk preterm infants,with high-risk preterm infants exhibiting more pronounced delays.Understanding the physical and neuropsychological development of premature infants correctly and formulating individualized early intervention mode play a crucial role in physical and neuropsychological development of premature infants.