影响新生儿神经行为发育的多因素分析

Multivariate Analysis of Factors Affecting Neonatal Neurobehavioral Development

目的探讨影响新生儿神经行为发育的多种因素及敏感性。方法随机选取中国第一冶金建筑公司职工医院妇产科1999年1～10月出生的足月新生儿103例,用鲍秀兰的20项新生儿神经行为检查法测定新生儿神经行为能力,用武汉科技大学医学院附属医院儿科设计的问卷收集有关影响因素,同时测定新生儿脐血铅和胎粪铅含量。以新生儿神经行为总评分作为因变量,以问卷中的影响因素及脐血铅、胎粪铅等24项指标作为自变量,采用多项有序分类反应型变量的logistic逐步回归的分析方法,在P=0.10水平筛选出相应的影响因素。结果孕周、孕期服药月份、血红蛋白、孕期情绪、胎粪铅、孕期服药6项选入模型。结论新生儿神经行为发育受多项因素的影响。孕期营养状况好、孕周长、孕期情绪好有利于新生儿神经行为的发育。孕期服药不利于新生儿神经行为的发育,尤其是妊娠早期用药。胎粪铅含量增高将不利于新生儿神经行为的发育。

Objective To investigate the environmental factors affecting neonatal neurobehavioral development and its sensitivities.Methods Neonatal behavioral neurological assessment (NBNA)and lead levels in umbilical cord blood and meconium were determined for103randomly selected neonates delivered at the section of Obstetrics and Gynecology,First Metallurgical Construction Company Hospital,from January to October1999,and the other relevant factors were investigated by questionnaire at the same time.The NBNB total score was described as a dependent variable and24relevant factors such as umbilical cord blood lead and meconium lead level,etc,as independent variables.Logistic regression analysis was used to ana-lyze the associated factors at P=0.10level.Results The factors selected in the Logistic regression model included:gestational age,month of taking medicine in gestational period,hemoglobin concentration,pregnant womans psychology,meconium lead level and taking medicine during gestational period.Conclusion Neonatal neurobehavioral development could be affected by many factors.Good nutrition,longer gestational age and maintaining good psychological status during pregnancy might be benefi-cial to neonatal neurobehavioral development.However,taking medicine during the gestational period and a high meconium lead level could be harmful to neonatal neurobehavioral development.