181例早产儿神经行为发育的回顾性研究

Neurobehavioral development in preterm infants：a retrospective study of 181 cases

摘要:

目的 通过收集早产儿随访的Gesell 发育量表评价结果，分析早产儿神经行为发育预后及可能的高危因素。方法 收集181 例早产儿及其母亲的资料，以及纠正年龄（CA）2 个月至1 岁时Gesell 发育量表测定的发育商（DQ）进行统计分析。结果 （1）出生体重（BW）<1 500 g 的早产儿，在适应性、大运动、精细动作等的DQ 值低于BW ≥ 1 500 g 的早产儿（P<0.05）。（2）胎龄（GA）<32 周的早产儿，在适应性、大运动、精细动作和个人社交的DQ 值低于GA ≥ 32 周早产儿（P<0.05）。（3）Gesell 5 个能区的DQ 值与GA、BW 均呈显著正相关（P<0.05）。多个能区的DQ 值与新生儿期多种并发症呈显著负相关（P<0.01）。结论 BW<1 500 g、GA<32 周早产儿是发生适应性、大运动、精细运动和个人社交等行为问题异常的高危人群，需密切随访；严重的新生儿期多种并发症可能与长期不良神经系统预后相关联，需积极预防处理。

Abstract:

Objective To investigate the results of Gesell Developmental Scale in follow-up of preterm infants and to determine possible high-risk factors for poor long-term neurological outcome. Methods A preterm infants' questionnaire was designed, and a retrospective study was conducted on the clinical data of 181 preterm infants (corrected age 2-12 months) and their mothers. The developmental quotient (DQ) scores were determined by the Gesell Developmental Scale and statistically analyzed. Results Compared with those with a birth weight (BW) of ≥1 500 g, the preterm infants with a BW of <1 500 g had significantly reduced DQ scores of adaptability, gross motor movement, and fine movement (P<0.05). Compared with those with a gestational age (GA) of ≥32 weeks, the preterm infants with a GA of <32 weeks had significantly reduced DQ scores of adaptability, gross motor movement, fine movement, and social contact (P<0.05). DQ scores on five Gesell subscales were significantly positively correlated with GA and BW (P<0.05). The DQ scores on Gesell subscales showed a significant negative correlation with severe complications in neonatal period (P<0.001). Conclusions For preterm infants, BW <1 500 g and GA <32 weeks are high-risk factors for abnormal adaptability, gross motor movement, fine movement, and social contact, and this group of infants should be followed up closely. Severe complications in neonatal period may be associated with poor long-term neurological outcome and should be effectively prevented and treated.