晚期早产儿和早期足月儿1岁时神经心理发育水平的随访研究

Neuropsychological development of late preterm infants and early term infants at the age of 1 year: a follow-up study

摘要:

目的 探讨晚期早产儿和早期足月儿1岁时的神经心理发育水平。方法 选择矫正年龄为1岁的1 257名儿童为研究对象。根据其出生时胎龄分为4组：早期早产儿（胎龄28~33⁺⁶周）、晚期早产儿（胎龄34~36⁺⁶周）、早期足月儿（胎龄37~38⁺⁶周）及完全足月儿（胎龄39~41⁺⁶周）。采用Gesell发展量表评估其神经心理发育水平，比较各组儿童在1岁时神经心理发育状况。结果 4组儿童1岁时5大能区（适应性、大运动、精细动作、语言、个人社交）发育商的差异均有统计学意义（P < 0.05），且均表现为完全足月儿 > 早期足月儿 > 晚期早产儿 > 早期早产儿的趋势（P < 0.05）；各能区发育迟缓率也均表现为完全足月儿最低，早期早产儿最高（P < 0.05）。与完全足月儿相比，早期足月儿适应能力发育落后的风险增加（OR=1.796，P < 0.05）；晚期早产儿适应能力和精细动作发育落后的风险较高，OR值分别为2.651、2.679（P < 0.05）；早期早产儿适应能力、精细动作和个人社交能力发育落后的风险较高，OR值分别为4.069、3.710、3.515（P < 0.05）。结论 儿童1岁时神经心理发育落后的风险随出生胎龄的增加而降低，呈现剂量反应效应。早期足月儿和晚期早产儿仍然存在不同程度的发育落后，应重视早期足月儿和晚期早产儿的保健随访。

Abstract:

Objective To study the level of neuropsychological development in late preterm infants and early term infants at the age of 1 year. Methods A total of 1 257 children with a corrected age of 1 year were enrolled as subjects. According to gestational age at birth, they were divided into an early preterm group (28-33⁺⁶ weeks), a late preterm group (34-36⁺⁶ weeks), an early term group (37-38⁺⁶ weeks), and a full-term group (39-41⁺⁶ weeks). Gesell Developmental Schedules were used to assess the neuropsychological development of the children, and the groups were compared in terms of neuropsychological development at the age of 1 year. Results There were significant differences in the developmental quotients of the five functional areas (adaptability, gross motor, fine motor, language and social ability) between the four groups at the age of 1 year (P < 0.05), and the full-term infants had the highest development quotients, followed by the early term infants, the late preterm infants, and the early preterm infants (P < 0.05). The full-term infants had the lowest rate of developmental delay in each functional area, while the early preterm infants had the highest rate (P < 0.05). Compared with the full-term infants, the early term infants had a higher risk of developmental delay in adaptability (OR=1.796, P < 0.05), and the late preterm infants had a higher risk of developmental delay in adaptability (OR=2.651, P < 0.05) and fine motor (OR=2.679, P < 0.05), while the early preterm infants had a higher risk of developmental delay in adaptability (OR=4.069, P < 0.05), fine motor (OR=3.710, P < 0.05), and social ability (OR=3.515, P < 0.05). Conclusions The risk of neuropsychological developmental delay decreases with the increase in gestational age in children at the age of 1 year, with a dose-response effect. There are varying degrees of developmental delay in early term infants and late preterm infants, and health care follow-up for early term infants and late preterm infants should be taken seriously.