疑似神经行为发育迟缓幼儿相关影响因素研究

Study on influencing factors of neurobehavioral development in young children suspected of developmental delays

目的通过调查顺德区24~60月龄幼儿神经行为发育情况,探讨幼儿发育影响因素,为幼儿神经行为发育异常的干预提供参考。方法采用回顾性队列研究方法,将经小儿神经心理发育量表初筛分数≤85分的幼儿纳入研究。初筛分数≤85分可能存在发育迟缓的风险,需进一步采用GESELL发育诊断量表进行发育迟缓的诊断,调查幼儿出生时的基本信息和其母亲的基本信息,以及收集幼儿完成GESELL发育诊断量表时的基本信息。结果共纳入幼儿271例,男童196例、女童75例。幼儿5个能区中语言能区发育商最低(P<0.001)。多重线性回归分析结果显示:与女童比较,男童语言能区发育商降低5.321分(P=0.049,95%CI:-10.620~-0.021),个人-社交能区发育商降低4.474分(P=0.023,95%CI:-8.316~-0.631);与自然分娩幼儿比较,剖宫产幼儿大运动能区发育商降低4.890分(P=0.008,95%CI:-8.499~-1.281),精细动作能区发育商降低3.373分(P=0.037,95%CI:-6.532~-0.213),语言能区发育商降低7.621分(P=0.004,95%CI:-12.826~-2.416),个人-社交能区发育商降低6.232分(P=0.001,95%CI:-10.006~-2.457)。二分类Logistic回归分析结果显示:与自然分娩幼儿比较,剖宫产幼儿大运动能区发育迟缓风险增加(OR=1.763,95%CI:1.003~3.100),精细动作能区发育迟缓风险增加(OR=2.217,95%CI:1.235~3.980),语言能区发育迟缓风险增加(OR=3.306,95%CI:1.080~10.124)。结论疑似神经行为发育迟缓的幼儿语言能区发育较其他能区落后,且男童语言及个人-社交能区发育商较女童低,剖宫产幼儿发育较自然分娩幼儿迟缓。应重点关注幼儿语言以及男童语言、个人-社交发育情况,慎重选择分娩方式,重视在早期对幼儿展开全面神经行为发育的评估。

Objective To investigate the neurobehavioral development of young children aged 24 to 60 months in Shunde and explore the factors influencing the development of young children and provide reference for the intervention of neurobehavioral development delays in young children.Methods A retrospective cohort study was used to enroll the young children who were initially screened by the Pediatric Neuropsychological Developmental Scale(Pediatric Heart Scale)with a score of≤85 was included in the study.With a score of≤85,the young children might be at risk of developmental delays,and needed to be further diagnosed by the GESELL Developmental Diagnostic Scale,the basic information of the young children and their mothers at the time of birth were investigated,as well as basic information about the young children at the time of completing the GESELL Developmental Diagnostic Scale was collected.Results A total of 271 young children were included,196 males and 75 females.Young children had the lowest developmental quotient(DQ)in the language domain among the five domains(P<0.001).Multiple linear regression models showed:compared with girls,the language domain DQ of boys decreased by 5.321 points(P=0.049,95%CI:-10.620--0.021),and the personal-social domain DQ decreased by 4.474 points(P=0.023,95%CI:-8.316--0.631).Compared with young children via natural vaginal delivery(NVD),the gross motor domain DQ of young children via caesarean section(CS)decreased by 4.890 points(P=0.008,95%CI:-8.499--1.281),the fine motor domain DQ decreased by 3.373 points(P=0.037,95%CI:-6.532--0.213),the language domain DQ decreased by 7.621 points(P=0.004,95%CI:-12.826--2.416),personal-social domain DQ decreased by 6.232 points(P=0.001,95%CI:-10.006--2.457).The results of binary logistic regression models showed,compared with young children via NVD,the risk of gross motor domain retardation in young children increased(OR=1.763,95%CI:1.003-3.100),the risk of fine motor domain retardation increased(OR=2.217,95%CI:1.235-3.980),the risk of language domain retardation increased(OR=3.306,95%CI:1.080-10.124).Conclusion Young children with suspected neurobehavioral delays were more likely to have delayed development in language domain than in other domains,boys had lower DQ in language domain and personal-social domain than girls,and the development of young children via CS was slower than that via NVD.Focus should be on the language development of young children especially on the language and personal-social development of boys.Carefully chose delivery way.Focus should be placed on assessment of young children′s comprehensive neurobehavioral development in early time.