超/极低出生体质量儿出生后1年生存情况分析研究  

Analysis of development condition in infants with very low and extremely low birth weight after birth of one year

作　　者：章晓婷[1] 龚华[1] 陈文[1] 赵祥群 李明英 钟晓云[1] Zhang Xiaoting;Gong Hua;Chen Wen;Zhao Xiangqun;Li Mingying;Zhong Xiaoyun(Department of Neonatology,Chongqing Health Care Hospital for Women and Children)

机构地区：[1]重庆市妇幼保健院新生儿科,重庆401120

出　　处：《重庆医科大学学报》2020年第8期1193-1197,共5页Journal of Chongqing Medical University

基　　金：重庆市科委自然科学基金资助项目(编号:cstc2012jjA1684);重庆市卫健委医学科研资助项目(编号:2017MSXM109)。

摘　　要：目的:通过出院后的系统化随访探讨超/极低出生体质量儿出院后的中远期预后情况。方法:2013年3月至2017年6月入住重庆市妇幼保健院新生儿科新生儿重症监护病房的极低出生体质量儿(含超低出生体质量儿)218例,出院后定期回科室随访门诊完成体格发育、神经系统发育评测,获得相关测评数据;同时接受个体化的早期干预。结果:218例纳入对象中,超低出生体质量儿25例。218例对象中,最小胎龄25+6周,最小出生体质量650 g;平均胎龄(31.06±1.52)周,平均出生体质量(1.27±0.18) kg。随访至矫正(14.53±2.36)个月,身高、体质量及头围小于同年龄同性别2个标准差者分别为5.05%、5.50%及2.65%;贝利婴儿发展量表完成神经行为测评的智力发育指数(mental development index,MDI)和运动发育指数(psychomotor development index,PDI)均≤69分者18例(8.26%)、均≥80分107例(49.08%);3例(1.37%)患儿确诊为脑性瘫痪。根据出生体质量分组,超低出生体质量组(n=25)MDI评分[(74.84±13.30)分]明显低于极低出生体质量组[(n=193,(81.47±11.86)分]。根据不同出生胎龄分组,胎龄<28周组的MDI评分明显低于其他2组(28~31+6周组和≥32周组)。MDI和PDI评分异常组(<70分)头颅磁共振成像(magnetic resonance imaging,MRI)异常及母亲妊娠胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)发生率高于评分正常组。Logistic逐步回归分析发现,头颅MRI异常、母亲ICP是发生神经发育损伤的危险因素。结论:超/极低出生体质量儿生长发育滞后发生率较高;胎龄越小,出生体质量越轻者,神经发育滞后发生率越高。需要长期规范随访及早期干预,减少严重并发症和后遗症。Objective:To investigate the middle-term and long-term prognosis of very low birth weight(VLBW) and extremely low birth weight(ELBW) infants after discharge through a systematic follow-up. Methods:A total of 218 VLBW(including ELBW) infants admitted in neonatal intensive care unit of our department from 03/2013 to 06/2017 were regularly returned to the follow-up clinic to take evaluations of physical development and nervous system development and accept individualized early intervention.Results:Among those 218 infants,25 were ELBW infants,the minimum gestational age was 25 +6 weeks,and the minimum birth weight was(650) g;the average fetal age was(31.06±1.52) weeks,and the average birth weight was(1.27±0.18) kg. Follow-up to a corrected age of(14.53±2.36) months,height,body mass and head circumference lower than two standard deviations with same age and gender were 5.05%,5.50% and 2.65%,respectively. Mental development index(MDI) and psychomotor development index(PDI)were performed in accordance with the Bayley Scales of Infant Development,18 infants had MID and PDI scores≤69(8.26%),107 infants MID and PDI scores≥80(49.08%) and three infants(1.37%) were diagnosed with cerebral palsy. Grouped in terms of birth weight,MDI score in the ELBW group(n=25) was(74.84±13.30),which was significantly lower than that of(81.47±11.86) in the VLBW group(n=193). Grouped in terms of gestational age,MDI score in the group with gestational age <28 weeks group was significantly lower than that in the other two groups(group with gestational age of 28-31+6 weeks and group with gestational age ≥32 weeks). In the group with abnormal MDI and PDI scores(score<70),incidence of abnormal cranial magnetic resonance imaging(MRI) and intrahepatic cholestasis of pregnancy(ICP) was higher than that in the group with normal scores. Stepwise Logistic regression analysis was performed and showed that abnormal cranial MRI and ICP were risk factors for neurodevelopmental injury. Conclusion:ELBW/VLBW infants have a higher incidence of growth

关 键 词：超低出生体质量儿 极低出生体质量儿 预后 

分 类 号：R722.6[医药卫生—儿科]