无明显脑损伤早产儿早期口腔吸吮模式与6月龄时神经发育结局相关性研究  

The association between early sucking patterns and neurodevelopmental outcomes at 6 months corrected age in preterm infants without obvious brain injury

作　　者：周梅[1] 尹华英[1] 程茜[1] 李语薇 文静[1] 

机构地区：[1]重庆医科大学附属儿童医院儿保科,儿童发育疾病研究教育部重点实验室,儿科学重庆市重点实验室,重庆市儿童发育重大疾病诊治与预防国际科技合作基地,重庆410014

出　　处：《中国循证儿科杂志》2016年第1期8-12,共5页Chinese Journal of Evidence Based Pediatrics

基　　金：重庆市卫生局医学科研项目:渝卫科教[2011]47号-2011-2-251);2013至2014年度国家临床重点专科建设项目:国卫办医涵[2013]544号

摘　　要：目的对无明显脑损伤早产儿早期口腔吸吮模式与6月龄时神经发育结局行相关性分析,为早产儿早期神经干预提供依据。方法纳入2013年10月至2015年4月重庆医科大学附属儿童医院住院的、无明显脑损伤的、胎龄〉28周的早产儿。以新生儿口腔运动评估量表（NOMAS）作为诊断工具用于早产儿吸吮问题的评估。通过直接或间接（录像）方法观察早产儿的进食行为,根据吸吮过程中舌、颊的运动和节律等28个条目的评估,分为吸吮模式正常、紊乱和障碍。在矫正年龄6月龄时完成贝利婴幼儿发展量表（BSID）的测试,于BSID测试当日行体格测量。结果 128例无明显脑损伤早产儿进入本文分析,BSID随访时平均矫正年龄（6.2±0.5）个月。口腔运动正常和异常组分别为73例和55例,两组基线情况差异均无统计学意义（P均〉0.05）。口腔运动正常组智力发展指数（MDI）和精神运动发育指数（PDI）均高于口腔运动异常组,差异均有统计学意义（P均〈0.05）。NOMAS条目吸吮-吞咽-呼吸不协调与婴儿早期的不利神经发育结局显著相关（RR=3.53,95%CI：1.48-8.42）。结论无明显脑损伤早产儿的早期正常口腔吸吮模式与6月龄时神经发育结局有明显相关性,但异常吸吮模式对神经发育延迟的预测意义有待进一步随访研究,吸吮-吞咽-呼吸不协调可能预示不利的神经发育结局。Objective To investigate the association between early sucking patterns and neurodevelopmental outcomes in preterm infants without obvious brain injury. Methods Sucking behaviors of 128 preterm infants born at 28 to 37 weeks of gestation were videotaped. The Neonatal Oral-Motor Assessment Scale（ NOMAS） was used to assess initial 2-min sucking behaviors of the subjects. The subjects were divided into normal and abnormal sucking pattern groups based on the NOMAS scores at 36 - 37 weeks postmenstrual age. At 6 months corrected age,infants were administered the Bayley Scales of Infant Development（ BISD） test and anthropometry measurements. Results The infants in abnormal sucking pattern group had significantly lower Mental Development Index and Psychomotor Development Index of the BISD than normal sucking pattern group（ P = 0. 002,P = 0. 032）. Infants in abnormal sucking group showed a higher rate of below average scores than normal group（ P = 0. 026）. The incoordination of sucking,swallowing,and breathing significantly increased the odds of adverse neurodevelopmental outcomes at 6 month corrected age（ RR = 3. 53,95% CI： 1. 48- 8. 42）. Conclusion Sucking patterns in preterm infants without obvious brain injury are associated with adverse neurodevelopmental outcomes. But the clinical predictive value of abnormal sucking patterns for developmental delay needs to be determined in a longer term follow-up. Incoordination of sucking,swallowing,and breathing may be an early signal of adverse neurodevelopmental outcomes.

关 键 词：早产儿 吸吮模式 神经发育 评估 

分 类 号：R722.6[医药卫生—儿科]