极低出生体重儿体格发育与神经发育关系的研究  

Growth and neurodevelopmental outcome of very low birth weight preterm infants at a teritiaryneonatal center

作　　者：桑田[1] 王颖[1] 胡秀丽[2] 冯琪[1] 张欣[1] 李星[1] 茹喜芳[1] 宋秀婷[1] 

机构地区：[1]北京大学第一医院儿科,100034 [2]河北工程大学附属医院新生儿科

出　　处：《中国新生儿科杂志》2016年第3期161-167,共7页Chinese Journal of Neonatology

摘　　要：目的动态监测极低出生体重早产儿的体格发育指标,探寻其宫内生长、生后早期及院外生长速率与婴儿期神经发育的相关性。方法回顾性分析2005年1月至2013年8月期间生后24 h入住我院新生儿监护病房并存活出院的极低出生体重(出生体重<1 500 g)早产儿。体格发育指标以头围和体重的标准差分数(SDS)表示,智力运动发育情况以Gesell发育诊断量表评价。使用LMS growth软件进行SDS计算,SPSS 16.0软件进行描述性分析及Logistic回归分析。结果符合纳入标准患儿共221例,排除参与其他随访项目的患儿52例,纳入分析169例,规律随访患儿138例,随访率81.7%,随访中位校正年龄34.3周,出生、出院及末次随访时生长迟缓(体重SDS≤-2)发生率分别为21.0%、35.0%和7.2%;头围SDS≤-2发生率分别为14.5%、14.5%和19.6%。中位校正周数37.9周的Gesell发育筛查提示适应性、大运动、精细运动、语言及个人社交发育商(DQ)轻中度落后的比例分别为3.8%、19.1%、4.8%、4.8%和2.9%。以二项式Logistic回归分析智力运动发育预后的相关因素,提示生长指标中,头围增长(随访头围SDS-出生头围SDS)与大运动显著相关(P=0.028)。结论极低出生体重儿大运动发育落后最为常见。绝大部分极低出生体重儿的体重在院外实现了追赶性生长,但头围发育落后比例呈上升趋势。头围增长与大运动发育显著相关,提示生后早期营养情况对远期神经发育有一定影响。Objective To study the growth and neurodevelopmental outcome of very low birth weight preterm infants to determine whether infantile growth is associated with neurodevelopmental outcome in these patients. Methods Surviving preterm infants who were born between Jan 2005 and Aug 2013 with a birth weight 〈1 500 g and admitted to NICU within 24 hours after birth were retrospectively collected. Growth was assessed on the basis of SD scores（ SDSs） of head circumference and body weight,neurodevelopmental outcome was evaluated by Gesell Developmental Schedules. SDSs were computed by using the Microsoft Excel add-in LMSgrowth. Statistical analysis were achieved by SPSS 16. 0. Results Among a total of 221 infants who met the criteria,52 infants were excluded as they participated another follow-up project. 138（ 81. 7%） of 169 infants were evaluated at a median corrected age of 34. 3 weeks. The incidences of SDS≤- 2. 0 measured as weight at birth,discharge and follow-up were 21. 0%,35. 0% and 7. 2%,the incidences of head circumference retardation at birth,discharge and follow-up were 14. 5%, 14. 5% and 19. 6%, respectively. Gesell Developmental Schedules evaluated at a median corrected age of 37. 9 weeks showed that incidence of mild to moderate delay ranged from 2. 9% to 19. 1% of different strands. Binary Logistic Regression analysis suggested that catch up growth of head circumference from birth to follow-up associated with a reduced risk for impaired gross motor development（ P = 0. 028）. Conclusions Delay of gross motor is relatively common in very low birth weight infants. Majority of infants caught up body weight growth after discharge,but the percentage of delayed head circumference increased. Head circumference growth from birth to follow-up seemed to be associated with gross motor development. Improving early infantile growth may improve long-term outcome in very low birth weight infants,whereas the effects of improved growth may only be limited.

关 键 词：婴儿 极低出生体重 生长迟缓 神经发育 随访 

分 类 号：R722.6[医药卫生—儿科]