6家医院147例脑损伤早产儿的多中心随访报告

Multicenter follow-up report of 147 premature infants with brain injuries from 6 hospitals in China

摘要:

目的：在中华医学会儿科学分会新生儿学组的发起下，国内十余家三级甲等医院于2005年1月始进行了为期20月的《早产儿脑损伤》多中心协作研究。该文报告其中6家医院对脑损伤早产儿临床随访的调查结果。方法：2005年1月至2006年8月期间，6家医院对在新生儿早期诊断为脑室内出血（IVH）和脑室周围白质软化（PVL）的早产儿出院后进行定期随访，综合体格、神经系统、智力测试及头颅B超随访结果，将早产儿列为正常、边缘水平及发育不良。结果：6单位147例脑损伤早产儿中，IVH 141例，PVL 36例，其中30例合并IVH＋PVL。总评价结果呈正常为51.4％，呈边缘水平或发育不良分别为38.4％和10.7％。头围、身长、体重均落后者占13.4％；脑瘫发生频率在I级PVL为 7.1％，II级PVL为28.6％，III级PVL为100％；智力测试显示12.7％呈现发育迟缓；头颅B超结果显示30％呈现脑损伤后遗改变。结论：该多中心调查数据可基本反映我国主要大城市脑损伤早产儿短期预后状况，约10％脑损伤早产儿呈现体格、运动及智能发育不良预后。期待各单位继续对更多脑损伤早产儿进行长期跟踪随访，尤其宜关注围学龄期及青春期可能发生的行为问题。［中国当代儿科杂志，2009，11（3）：166-172］

Abstract:

OBJECTIVE: Sponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association, more than 10 large-scale hospitals participated in the near two-year multicenter investigation for Brain Injuries in Premature Infants in China. The present study presents the follow-up results of 147 premature infants with brain injuries from 6 Third Class A Level hospitals. METHODS: All premature infants with intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) diagnosed in the early neonatal period in the 6 hospitals were followed-up between January 2005 and August 2006. Based on the synthetic results of physical development, examination of nervous system, intelligence tests and cranial ultrasound, the premature infants with brain injuries were classified as normal development, marginal development and retarded development. RESULTS: One hundred and forty-seven premature infants with brain injuries from the 6 hospitals consisted of 141 cases of IVH and 36 cases of PVL (30 cases having IVH and PVL). Based on the synthetic follow-up results, 51.4% of premature infants with brain injuries were generally assessed as normal development, 38.4% as marginal development and 10.7% as retarded development. Among them, delayed growth in head circumference, height and weight was 13.4%; the occurrence frequency of cerebral paralysis (CP) was 7.1% in PVL grade I, 28.6% in PVL grade II and 100% in PVL grade III; 12.7% showed retarded development of intelligence; and 30% presented post-injurious changes on cranial sonography. CONCLUSIONS: The data of the multicenter follow-up can basically reflect the short-term prognosis of premature infants with brain injuries in major big cities of China. About 10% of them have retarded physical, motor-and mental developments. The long-term regular follow-up study is expected for more premature infants with brain injuries, and behavioral sequelae of brain injuries which may occur in peri-school age and adolescence should be paid particularly close attention.［Chin J Contemp Pediatr, 2009, 11 (3):166-172］