宫内发育迟缓早产儿生后生长迟缓对早期神经发育的影响

目的 探讨宫内发育迟缓(IUGR)早产儿生后生长迟缓对早期神经发育的影响。方法 回顾性分析2008 年5 月至2012 年5 月出生并定期随访至校正胎龄6 个月的171例早产儿的临床资料,其中IUGR早产儿40 例,早产适于胎龄儿(AGA)131 例。比较两组校正胎龄40 周、3个月、6个月的生长迟缓率及校正胎龄3 个月、6 个月时的神经发育情况。神经发育采用Gesell发育量表评估。结果 IUGR 组校正胎龄40 周、3个月、6个月的生长迟缓率均明显高于AGA 组;校正胎龄3 个月时Gesell 各项发育商(大运动、精细动作、语言、适应性及个人社交)均低于AGA 组;校正胎龄6 个月时,IUGR组精细动作及语言发育商低于AGA组,但两组大运动、适应性及个人社交发育商比较差异已无统计学意义。IUGR组6月龄时体重追赶落后的患儿各项发育商均明显低于追赶理想的IUGR 和AGA 患儿。结论 IUGR早产儿生后早期的生长迟缓可对早期神经发育产生不良影响。

Effects of postnatal growth retardation on early neurodevelopment in premature infants with intrauterine growth retardation

Objective To study the effects of postnatal growth retardation on early neurodevelopment in premature infants with intrauterine growth retardation (IUGR).Methods A retrospective analysis was performed on the clinical data of 171 premature infants who were born between May 2008 and May 2012 and were followed up until a corrected gestational age of 6 months. These infants were classified into two groups:IUGR group (n=40) and appropriate for gestational age (AGA) group (n=131). The growth retardation rates at the corrected gestational ages of 40 weeks, 3 months, and 6 months, as well as the neurodevelopmental outcome (evaluated by Gesell Developmental Scale) at corrected gestational ages of 3 and 6 months, were compared between the two groups.Results The growth retardation rate in the IUGR group was significantly higher than in the AGA group at the corrected gestational ages of 40 weeks, 3 months, and 6 months. All five developmental quotients evaluated by Gesell Developmental Scale (gross motor, fine motor, language, adaptability and individuality) in the IUGR group were significantly lower than in the AGA group at the corrected gestational ages of 3 months. At the corrected gestational age of 6 months, the developmental quotients of fine motor and language in the IUGR group were significantly lower than in the AGA group, however, there were no significant differences in the developmental quotients of gross motor, adaptability and individuality between the two groups. All five developmental quotients in IUGR infants with catch-up lag in weight were significantly lower than in IUGR and AGA infants who had caught up well.Conclusions Growth retardation at early postnatal stages may adversely affect the early neurodevelopment in infants with IUGR.