高危新生儿智力发育的随访研究

目的:纵向了解高危儿的发育情况,探讨高危因素造成神经系统损害和智力缺陷的可能性及远期预后的影响.方法:1994年3月至1995年5月住院治疗的高危新生儿122例,6个月、1周岁参照Gesell发育量表做运动、精神发育评估;6～7岁采用中国-韦氏儿童智力量表(C-WISC)进行测试.结果:多因变量单因素方差分析显示低血糖和早产对6～7岁儿童总智商、语言智商、操作智商均有显著性影响(P＜0.05),其余高危因素的危险性排序依次为低出生体重、严重缺氧、出生时窒息、红细胞增多症、高胆红素血症;有1项高危因素的与有2项及2项以上高危因素的新生儿比较,差异有显著性(P＜0.05);6个月与1周岁、6个月与6～7岁、1周岁与6～7岁智力发育水平呈正相关(r=0.321、0.343、0.463,P均<0.01).结论:出生时的高危因素对儿童智力发育的影响不容忽视,尤其是有多项高危因素的新生儿造成发育障碍的可能性大大增加.6个月和 1周岁的发育对远期预后有预测意义.

Follow-up study of mental developments in high-risk children

Objective: To study the mental developments in high risk children and the impact of the high risk factors on neurologic abnormalities, mental defect and long term outcome. Methods: The mental development of 122 children who had been exposed to high risk factors and treated between March 1994 to May 1995 during their newborn periods was evaluated. Gesell development scales were performed when they were at 6 and 12 months old. And Wechsler intelligence scales for children (Chinese version) were performed at 6~7 years old. Results: The children exposed to hypoglycemia during their newborn period and preterm labor had significantly lower IQ, VIQ and PIQ scores ( P <0.05). The other risk factors in order were low birth weight, severe anoxia, asphyxia at birth, erythrocythemia, hyperbilirubinemia. There was significant difference between the children exposed to one risk factor and those exposed to two or more risk factors ( P <0.05). And there was significant correlation between developmental assessment at 6 and 12 months and mental development at 6~7 years old ( P <0.01). Conclusion: The impact of the high risk factors at birth on children's mental development is not negligible. And the risk of development abnormalities will increase if the children were exposed to multiple risk factors. The evaluation of development at 6~12 months is of predictive value for long term outcome.