极低出生体重儿早期体格追赶生长和神经发育随访及影响因素分析  

Follow-up and influencing factors of very low birth weight infants with early physical growth and neurodevelopment

作　　者：龚倩 杨小云[1] 台晓燕[1] 徐家丽[1] GONG Qian(Department of pediatrics,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,China)

机构地区：[1]蚌埠医学院第一附属医院儿科,安徽蚌埠233000

出　　处：《牡丹江医学院学报》2020年第2期88-93,共6页Journal of Mudanjiang Medical University

摘　　要：目的调查我院极低出生体重儿(Very low birth weight infant,VLBWI)出生后6~7月内体格追赶生长状况和神经发育结果并寻找相关影响因素。方法按照纳入及排除标准,选取2017年1月至2019年4月间,我院新生儿重症监护室收治并定期在儿童康复门诊随访的148例VLBWI为研究对象,收集这部分患儿从出生至校正月龄(corrected age,CA)6~7月的体格生长参数(体重、身长和头围),根据有无追赶生长将患儿分为无追赶生长组(Z<-2)和追赶生长组(Z≥-2);CA 6~7月时采用盖塞尔(Gesell)量表,衡量神经发育结果,并分为神经发育正常组和神经发育异常组。通过多因素分析分别寻找影响追赶生长和神经发育的危险因素。结果 (1)148例VLBWI中,从出院、校正胎龄40±7周、CA3~4月至CA6~7月5个阶段中,Z<-2的比率在出院时最高,之后随着月龄增加而逐渐下降,各阶段比较均有显著差异(P<0.05)。(2)出院时,体重Z<-2的有75例,小于胎龄儿、低出生体重和低入院前白蛋白浓度是出院时体重Z<-2的高危因素;CA6~7月时,体重Z<-2的有16例,小于胎龄儿和低出生体重是CA6~7月时体重Z<-2的高危因素。(3)CA6~7月时,神经发育异常的比例为30.00%,小于胎龄儿是神经发育异常的危险因素。结论我院VLBWI的体格追赶生长状况及神经发育结果仍不容乐观,至CA6~7月,仍有部分VLBWI存在生长偏离,各阶段影响追赶生长的危险因素不尽相同。Objective To investigate the growth status and neurodevelopmental results of Very Low Birth Weight Infants(VLBWI)within 6 to 7 months after birth,and screen out related influencing factors.Methods According to the inclusion and exclusion criteria,from January 2017 to April 2019,148 VLBWI patients who were admitted to the neonatal intensive care unit of our hospital and regularly followed up in the child rehabilitation clinic were selected as the research subjects.Corrected age(CA)physical growth parameters(weight,length and head circumference)from June to July were collected.According to whether there was catch-up growth,the children were divided into no-catch-up growth group(Z<-2)and catch-up growth group(Z≥-2).Gesell scale was used to measure the neurodevelopmental results when CA was from 6 to 7,and infants were divided into normal neurodevelopmental groups and abnormal neurodevelopmental groups.Multi-factor analysis was used to find the risk factors affecting catch-up growth and neurodevelopment.Results(1)Of the 148 VLBWIs,the rate of Z<-2 was the highest at the five stages from discharge,corrected gestational age 40±7 weeks,CA 3 to April to CA 6 to 7,and then increased with the age of the month.However,it gradually declined,and there was a significant difference in the comparison of each stage(P<0.05).(2)There were 75 patients with a weight Z<-2 at discharge.Less than gestational age,low birth weight,and low pre-admittance albumin concentration were the high-risk factors for the weight Z<-2 at the time of discharge from the hospital.There were 16 cases with Z<-2,and gestational age and low birth weight were the high risk factors for Z<-2 from 6 to 7 months.(3)From 6 to 7 months of CA,the proportion of neurodevelopmental abnormalities is 30.00%,which is a risk factor for neurodevelopmental abnormalities in gestational age children.Conclusion The physical catch-up growth status and neurodevelopmental results of VLBWI in our hospital are still not optimistic.As of June to July,there are still some VLBWI grow

关 键 词：极低出生体重儿 追赶生长 神经发育 Z评分 

分 类 号：R722.6[医药卫生—儿科]