额叶皮质发育不良婴儿神经精神发育随访分析

Analysis of follow-up results of neuropsychological development in infants with frontal cortex displasia

目的 评估新生儿缺氧缺血性脑病 (HIE)所致额叶皮质萎缩在神经精神发育方面的预后。方法 自1997年 4月至 1999年 9月对 5 18例额叶皮质发育不良患儿在抽搐发作、睡眠行为、注意能力、语言发育、神经运动、依恋情感和认知水平方面定期评价至 3岁龄。结果 4月龄后发生无热抽搐 86例 (16 6 % ) ,在 18～ 30月龄间出现热性惊厥 2 6例 (5 0 % )。 4月龄出现 1项以上睡眠异常 2 5 6例 (49 4 % ) ,18月龄有 2～ 3项睡眠异常 5 3例 (10 2 % )。 8月龄注意能力异常 194例 (37 5 % ) ,3岁龄 6 8例异常 (13 3% )。 18个月龄运动性语言发育迟缓15 6例 (30 1% ) ,在 3岁龄时 ,运动性语言发育落后或构音异常 6 9例 (13 3% )。 4～ 8月龄期间 ,运动发育持续迟缓 4 2 6例 (82 2 % ) ,平均得 78 2分。 3岁龄运动发育迟缓者 14 1例 (2 7 2 % ) ,其中脑性瘫痪 32例。在 15月龄 2 4例 (4 6 % )依恋情感发展落后。结论 额叶皮质发育不良预后良好 ,但部分可能有远期的后遗症。应在婴儿早期常规检查头部CT或MRI。有额叶皮质发育不良者 ,需定期检查评价神经运动、精神发育、注意能力、语言发育水平和睡眠行为、依恋情感、脑电图等。

Objective To evaluate the prognosis of neuropsychological developmente of HIE infants with frontal cortex dysplasia.Methods The data of 518 infants with frontal cortex dysplasia on convulsion,sleep attention ability physical development,language development,attention ability,speech,psychomotor,attachment ,and cognitive development till three years old were assessed.Results Eighty-sxi infants (16.6%) had afebrile seizure beyond 4 months old; 26(5.0%)had febrile seizure between 18 and 30 months old;256(49.4%)had more than one item of sleep problems at 4 months old;53(10.2%) had 2 or 3 items of sleeping problems at 8 months old; 194(37.5%) had abnormal attention ability at 8 months old ;68(13.3%) had abnormal attention ability at three years old; 156 (30.1%) had speech delay at 18 months old;69(13.3%) had slightly delayed speech at three years old.426(82.2%)had motor delay (MD) between four and eight months old,with a mean score of 78.2 points;141 had motor delay,and 32 cerebral palsy included at three years old.24(4.6%) had delayed attachment development at 15 months.Conclusion The prognosis of frontal cortex dysplasia in infants is good,but some have long-term variable developmental disabilities.Therefore,it's necessary to examine HIE infants with head CT scan or MRI reasonably in early stage,and evaluate the psychmotor,mental,attention and speech development,and sleep,attachment,EEG in infants with frontal cortex dysplasia periodically.