新生儿缺氧缺血性脑病对婴儿期神经心理发育的影响

【目的】 探讨早期规范治疗的轻、中度新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy, HIE)患儿婴儿期神经心理发育水平,为HIE患儿的婴儿期发育评价及研究提供依据。 【方法】 将应用GM1规范治疗的轻、中度HIE患儿分别做为观察1组和观察2组,将与该类HIE患儿同期在本院出生的正常新生儿做为对照组,三组新生儿分别建立专科档案进行1年的随访,并均在3、6、12个月时,用Gesell婴幼儿发育量表进行测试评估。 【结果】 1)3个月时观察1组和观察2组的5个能区发育商(developmental quotient, DQ)均低于对照组,差异有高度统计学意义(P＜0.01);2)6个月时观察1组与对照组5个能区的DQ差异无统计学意义(P＞0.05);观察2组5个能区的DQ比对照组婴儿低,差异有统计学意义(P＜0.05);3)12个月时观察2组的精细动作和适应行为的DQ仍比对照组的相应能区低,差异有统计学意义(P＜0.05)。 【结论】 轻、中度HIE患儿在婴儿期可遗留智力发育及心理行为发育落后,但随着月龄的增加,智力及行为发育有个追赶过程,尤其在大运动、语言和个人社交方面追赶明显,轻度HIE患儿可达到正常儿发育水平;部分中度HIE患儿的精细运动和适应行为追赶缓慢,在今后的实践中,干预的重点是精细动作和适应行为。

Effect of neonatal hypoxic-ischemic encephalopathy on infant neurobehavioral development

【Objective】 To explore the neurobehavioral development condition of infants with mild or moderate neonatal hypoxic-ischemic encephalopathy(HIE) during early period of standard treatments.To provide the theory evidence for evaluation and study of infant neurobehavioral development with HIE. 【Methods】 Mild and moderate HIE infants were assigned into two groups based on GM1 treatment.Normal infants born in the same period at the Heilongjiang Hospital were used as control group.One-year regular visiting study was launched and infants from all three groups were assessed using Gesell table at 3 months,6 months,and 12 months old. 【Results】 1)At 3 months old,all developmental quotient(DQ) of the five items from group 1 and group 2 were lower than control group(normal infants) and there was very significant difference(P<0.001).2) At 6 months old,there was no significant difference between group 1(mild HIE infants) and control group(P>0.05) while significant difference exited between group 2 and control group(P<0.05).3)At 12 months old,there was still significant difference between group 2 and control group with respect of fine movements and adaptive behavior(P<0.05). 【Conclusions】 Mild and moderate hypoxic-ischemic encephalopathy may have a more slow neurobehavioral development than normal infants.As they grow up,intelligence and behavior will be gradually improved,such as coarse movement,language level and social communication.Moderate hypoxic-ischemic encephalopathy may have a slow improvement in fine movement and adaptive behavior.In future work,more attentions will be paid on interventions like fine movement and adaptive behavior.