轻度脑室内出血对脑损伤高危儿早期运动发育的影响

Effects of mild intraventricular hemorrhage on early motor development in infants with high risk of brain injury

目的探讨轻度脑室内出血(IVH)对脑损伤高危儿早期运动发育的影响,根据其特点指导干预。方法基于回顾性队列研究设计,选择2022年2月1日至2023年3月31日于西安市儿童医院新生儿病房出院,合并一种或多种脑损伤高危因素的高危儿,依据头颅超声是否存在轻度IVH诊断分为轻度IVH组和无IVH组,研究对象排除其他脑损伤疾病。采用婴儿运动能力测试(TIMP)评估运动发育,反映头部控制、对视听觉反应、防御运动、躯干运动、四肢运动等方面的发育。两组均于生后矫正年龄(CA)16周内完成TIMP测试,比较两组TIMP分值的差异。结果共纳入329例新生儿,轻度IVH组98例,无IVH组231例。轻度IVH组TIMP的Z值低于无IVH组(-0.25±0.87比0.03±0.71,P=0.015)。匹配脑损伤高危因素后进一步比较:CA 2~5周,轻度IVH组TIMP评分(分)总分(74.10±12.28比84.24±7.71)、观察项目(10.57±1.47比11.24±1.29)、引出项目(63.17±12.13比73.00±7.36)、坐位(9.14±2.90比11.65±3.26)、仰卧位(22.07±4.73比24.79±3.55)、俯卧位(10.35±3.74比12.82±3.15)、侧方位(4.00±2.85比5.48±2.13)的分值均低于无IVH组(P<0.05);CA 6-9周,轻度IVH组坐位(10.44±4.01比12.96±3.02)、仰卧位(24.04±4.60比26.83±3.53)、侧方位(4.83±2.53比6.25±2.6)的分值均低于无IVH组(P<0.05)。CA 12~15周,轻度IVH组总分(104.00±12.98比114.10±13.16)、引出项目(92.00±12.64比102.00±13.10)、坐位(17.00±3.50比19.13±3.55)、侧方位(7.35±2.14比9.00±2.37)的分值均低于无IVH组。结论轻度IVH影响脑损伤高危儿早期运动发育,主要表现为CA 2~5周时头控相关能力落后,且趋势会持续至CA 12~15周。脑损伤高危儿合并轻度IVH时应该进行早期运动能力监测及头控能力干预。

ObjectiveTo assess the effect of mild intraventricular hemorrhage(IVH)on the early motor development of infants at high risk of brain injury,and to guide the intervention according to its characteristics.MethodsA retrospective cohort study was conducted to select neonates discharged from the Neonatal Unit of Xi'an Children's Hospital from February 1,2022 to March 31,2023,with one or more high-risk factors of brain injury.The patients were assigned to low-grade IVH group and no IVH group according to ultrasound diagnosis.The research subjects exclucled other brain injury diseases besides mild IVH.Motor development was assessed using test of infant motor performance(TIMP),reflecting performance in head control,auditory and visual responses,defensive movements,trunk movements,limb movements,and more.Both groups completed TIMP assessment between discharge and 16 weeks of the corrected age(CA).The differences of TIMP scores between two groups were compared.ResultsA total of 329 neonates at high risk for brain injury were recruited,including 98 cases with gradeⅠ-ⅡIVH(low-grade IVH group)diagnosed through brain ultrasonography and 231 controls(no IVH group).The Z scores of TIMP in the low-grade IVH group were lower than that in no IVH group(-0.25±0.87 vs.0.03±0.71,P=0.015).The risk factors of brain injury were matched for further comparison.At CA2-5 weeks,the scores in low-grade IVH group of TIMP total scores(74.10±12.28 vs.84.24±7.71),observation items(10.57±1.47 vs.11.24±1.29),elicitation(63.17±12.13 vs.73.00±7.36),sitting(9.14±2.90 vs.11.65±3.26),supine(22.07±4.73 vs.24.79±3.55),prone position(10.35±3.74 vs.12.82±3.15)and lateral position(4.00±2.85 vs.5.48±2.13)were significantly lower than those in no IVH group(P<0.05).At CA6-9 weeks,the scores in low-grade IVH group of sitting position(10.44±4.01 vs.12.96±3.02),supine position(24.04±4.60 vs.26.83±3.53),lateral position(4.83±2.53 vs.6.25±2.6)were significantly lower than those in no IVH group(P<0.05).At CA12-15 weeks,the low-grade IVH group showed significant differences in TIMP total score(104.00±12.98 vs.114.10±13.16),elicitation(92.00±12.64 vs.102.00±13.10),sitting(17.00±3.50 vs.19.13±3.55)and lateral position(7.35±2.14 vs.9.00±2.37)compared with those from no IVH group(P<0.05).ConclusionMild intraventricular hemorrhage affected the early motor development of high-risk infants with brain injury,mainly manifested as a lag in the ability of head control at CA2-5 weeks,and the trend continued until CA12-15 weeks.Early monitoring of motor ability and intervention of head control ability should be carried out in high-risk children with mild intraventricular hemorrhage.