早期干预对小早产儿和极低出生体重儿矫正年龄1岁时神经发育的影响  

Early intervention impact on neurodevelopmental outcome of very preterm infants and VLBW infants at 1 year corrected age

作　　者：袁欣[1] 李霞[1] 李雪[1] 卓越[1] 范秀芳[1] 

机构地区：[1]济南市妇幼保健院新生儿科,250001

出　　处：《国际儿科学杂志》2015年第5期556-559,共4页International Journal of Pediatrics

基　　金：山东省医院卫生科技发展计划项目（2014W50012）

摘　　要：目的评价小早产儿（胎龄〈32周）和极低出生体重儿出院后神经运动发育状况及探讨早期干预的影响。方法自2012年1月至在济南市妇幼保健院重症监护室出院的小早产儿和极低出生体重儿共70例进行随访，根据出生体重分为两组，体重〈1500g38例，体重〉11500g 32例，随访时间为出院后7—10d及矫正胎龄40周，达矫正月龄1个月后每月1次至1岁。随访时进行体格测量（身长、体重、头围）、20项神经行为检查，矫正月龄6、12个月时分别进行CDCC婴幼儿智能发育量表评估，检测血常规、骨源性碱性磷酸酶、血生化，做颅脑超声、脑电图、颅脑核磁共振检查。对神经行为异常者进行以物理康复训练为主的综合干预治疗，采取以家庭为中心的疗育结合的干预模式。采用SPSS15．0软件进行统计学处理。结果70例患儿平均胎龄（30．4±1．8）周，平均出生体重（1463．7±307．5）g，宫外发育迟缓（extrauterine growth restriction，EUGR）发生率57．1％；矫正月龄6个月时神经发育损害（neurodevelopmental impairment,NDI）发生率14．3％，脑性瘫痪倾向6例（8．6％）；矫正月龄12个月研究组NDI发生率为2．9％，脑性瘫痪发生率2．9％，NDI发生率、智力发育指数、NDl分数比较差异有统计学意义。两组患儿NDI、神经运动发育指数〈70、智力发育指数〈70、脑性瘫痪发生率比较差异无统计学意义。结论早期干预可改善小早产儿和极低出生体重儿神经发育结局，降低神经发育损害发病率。Objective to evaluate neurodavelopmental outcome of very preterm（ gestational age 〈 32 weeks） and very low birth weight infant （VLBWI） （weight 〈 1 500 g） and to examine the effectiveness of an early intervention program till 12 months corrected age. Methods Seventy followed-up very preterms and VLB- WI in Jinan Maternity and Childcare Hospital were enrolled in this study from January 2012 to and were divided into two groups by birth weight. All infants received 20 items of behavioral neurological assessment at 1 to 12 months corrected age and tested mental and psychomotor development with the use of CDCC at 6,12 months corrected age. The preterms who were abnomal in the 20 items of behavioral neurological assessment would receive early intervention （including kinesitherapy, physiotherapy, cereal circulation therapeutic equipment） by physiotherapists and their parents who received an intervention program training and were strongly encouraged to participate in the intervention sessions. The intervention method was adjusted according to the neurological as- sessment. The SPSS statistical software package for Windows, version 15.0, was used to run Fisher＇s exact test and t-test on the data presented, and P value of less than 0. 05 was regarded as statistically significant. Results The average gestational age of infants was （30. 4 ± 1.8） weeks,and average birth weight （ 1 463. 7 ± 307.5 ） g. The incidence of extrauterine growth restriction was 57. 1% at first follow-up. The incidence of neurodevelpmental impairment NDI） and cerebral palsy tendency at 6 corrected months were 14. 3% ,8. 6% respectively. At 12 months corrected age,the incidence of NDI decreased to 2. 9% and cerebral palsy to 2. 9%. There was signifi- cant difference in the incidence of NDI between 6 and 12 corrected months. There was no significant difference in the incidence of psychomotor developmental index 〈 70, mental developmental index 〈 70, NDI and cerebral palsy between the two groups. Conclusion The early i

关 键 词：小早产儿 极低出生体重儿 婴幼儿智能发育量表 神经发育损害 脑性瘫痪 早期干预 

分 类 号：R722.6[医药卫生—儿科]