大于胎龄儿12月龄神经心理发育状况研究

Neuropsychological development of large for gestational age infants at the age of 12 months

摘要:

目的 探讨大于胎龄儿（large for gestational age, LGA）12月龄时神经心理发育水平。方法 选择2021年12月—2023年6月在山东第一医科大学第一附属医院儿童保健门诊就诊的12~<13月龄儿童为研究对象，按胎龄及出生体重分为早产适于胎龄儿（appropriate for gestational age, AGA）、早产LGA、早期足月AGA、早期足月LGA、完全足月AGA和完全足月LGA 6组，使用修正Poisson回归分析LGA与12月龄时神经心理发育结局的关系。结果 校正混杂因素后，与完全足月AGA相比，完全足月LGA 12月龄时语言发育异常的风险明显增加（RR=1.364，95%CI：1.063~1.750）；早期足月LGA 12月龄时粗大运动、精细运动、语言，以及早产LGA 12月龄时语言、社会行为发育异常及总发育商异常的风险增加（P<0.05）；早期足月AGA 12月龄时5大能区发育异常及总发育商异常的风险增加（P<0.05）；除语言能区外，早产AGA 12月龄时其余4大能区发育异常的风险增加（P<0.05）。结论 不同胎龄LGA在12月龄时神经心理发育均落后于完全足月AGA，临床应重视其随访并早期干预。

Abstract:

Objective To investigate the level of neuropsychological development in large for gestational age (LGA) infants at the age of 12 months.Methods The infants, aged 12 to <13 months, who attended the Outpatient Service of Child Care in the First Affiliated Hospital of Shandong First Medical University from December 2021 to June 2023, were enrolled as subjects. According to the gestational age and birth weight, they were divided into preterm appropriate for gestational age (AGA) group, preterm LGA group, early term AGA group, early term LGA group, full-term AGA group, and full-term LGA group. A modified Poisson regression analysis was used to investigate the association between LGA and neuropsychological development outcome at 12 months of age.Results After adjustment for confounding factors, compared with the full-term AGA group at the age of 12 months, the full-term LGA group had a significant increase in the risk of language deficit (RR=1.364, 95%CI: 1.063-1.750), the early term LGA group had significant increases in the risk of abnormal gross motor, fine motor, language, and the preterm LGA group had significant increases in the risk of abnormal language, social behavior, and total developmental quotient (P<0.05); also, the early term AGA group had higher risks of developmental delay across all five attributes and in total developmental quotient at the age of 12 months (P<0.05); except for the language attribute, the preterm AGA group had higher risks of developmental delay in the other 4 attributes (P<0.05).Conclusions The neuropsychological development of LGA infants with different gestational ages lags behind that of full-term AGA infants at 12 months of age, and follow-up and early intervention of such infants should be taken seriously in clinical practice.