中晚期早产儿不良神经发育结局的研究进展

近年来,随着医疗水平的不断提高,早产儿存活率得以大幅提升,但由于胎龄不足,早产儿相比足月儿不良神经发育结局发生的风险比例增高,神经发育问题逐渐成为早产儿早期发展面临的突出问题。中晚期早产儿约占早产儿总人数的80%,但目前极早产和超早产与神经发育障碍相关性的研究较多,中晚期早产与神经发育障碍相关性的研究较少。本文对中晚期早产儿神经发育结局进行综述,为临床早期评估中晚期早产儿神经发育状态提供依据。通过胎盘-脑轴生物标志物预测中晚期早产儿神经发育结局,对开展早期干预具有重要意义。     

支气管肺发育不良早产儿神经发育研究

支气管肺发育不良(BPD)是一种由肺发育不良引起的炎症性疾病，并与远期神经发育不良密切相关。BPD早产儿在运动、认知、神经感觉和行为等方面也存在发育障碍，但BPD引起早产儿神经发育不良的机制尚不明确。本文就BPD对早产儿神经发育的影响及潜在机制，包括高氧暴露、炎症、糖皮质激素、营养等进行综述，以期为BPD新型呼吸支持技术及相关神经发育障碍治疗提供参考。     

早产儿神经系统发育结局的研究进展

随着新生儿重症监护病房的建立和技术发展,危重早产儿存活率明显提高,但部分存活早产儿遗留脑瘫、运动发育迟缓、视听觉损害等神经发育障碍,严重影响早产儿的生存质量。早产儿远期的不良结局与营养、严重并发症等因素有关。早产儿神经元的发育可能延续至2岁,因此,对早产儿出院后的长期密切随访、评估,对发育异常者及时积极干预等措施可改善其神经系统发育结局。     

社会生态视角下早产儿神经发育影响因素的研究进展

早产儿神经发育障碍是全球重大的公共卫生问题,其影响因素众多且复杂。本文基于社会生态理论,从不同生态系统层面出发,对其神经发育相关的个体、家庭和社会政策因素进行综述,为优化早产儿预后结局提供新视角和新路径。     

早产儿矫正5～7月龄的体格和神经心理发育水平研究

目的 了解早产儿随访门诊早产儿在矫正5～7月龄的体格和神经心理发育水平及两者之间的相关性。方法 利用已开发的互联网+早产儿随访系统,组建早产儿共同照护团队,从2019年开始按照《早产儿保健工作规范》对深圳市宝安区妇幼保健院出生和辖区转诊的早产儿开展随访。分析早产儿在矫正5～7月龄的体格和神经心理发育水平,以及两者之间的相关性。结果 至矫正5～7月龄时,有53名(27. 0%)早产儿存在宫外生长迟缓。分别有9例(45. 0%)小于胎龄儿和22例(12. 7%)适于胎龄儿至矫正年龄5～7月龄,体重未能达到满意的追赶生长;而累积有32例(16. 3%)早产儿出现体重追赶生长过速。总计有25名(12. 8%)早产儿在矫正年龄5～7月龄时存在1个及以上能区的发育障碍或临界偏低水平(发展商≤79)。存在发育障碍或临界偏低水平组的早产儿,其在矫正5～7月龄接受首都儿童研究所《0～6岁儿童神经心理行为检查量表》(2016版)评估时的平均体重、身长均低于发育正常组,差异有统计学意义(P 0. 05)。结论 早产儿生后矫正5～7月龄的生长发育与神经心理发育水平存在相关性。对早产儿出院后营养进行科学管理是保障其神经心理发育正常发展的基础。     

婴幼儿早期神经发育评估诊断量表的综述

婴幼儿早期发育是儿童生命发展的关键时期,而早产儿和高危儿是发生神经发育障碍的高危群体,因此早发现、早干预对改善婴幼儿神经发育结局有着十分重要的意义。本文对国内外常用的婴幼儿神经发育评估诊断量表进行综述,包括Bayley婴幼儿发展量表、Gesell发育量表、Griffiths精神发育量表、中国儿童发育量表的发展史、应用现状及优缺点等,为儿科医生的临床评估提供参考依据。     

早产儿发育结局

随着近年新生儿重症监护救治水平提高, 早产儿尤其是超早产儿的存活率大幅度提升, 后遗症问题逐渐成为儿童早期发展面临的突出问题。早产可导致各系统器官损害, 影响生长发育、运动、语言、视听、认知及行为等, 出现神经发育障碍/缺陷。本文对早产儿发育结局进行综述。     

坏死性小肠结肠炎对52例早产儿神经发育的影响

目的 了解坏死性小肠结肠炎（necrotizing enterocolitis,NEC）及其严重程度对早产儿远期神经发育的影响,以期为早产儿神经发育障碍的诊治提供参考。方法 采用前瞻性队列研究,选取2018年1月—2021年11月收治于泉州市儿童医院的NEC早产儿52例、非NEC早产儿104例为研究对象,应用Gesell发育量表在幼儿期评估其神经发育水平,将发育商（development quotient,DQ）≤85定义为神经发育异常。分析NEC早产儿与非NEC早产儿的神经发育异常发生率以及体格发育情况等指标。结果 在矫正25(20,28)月龄时,NEC组的年龄别身高Z评分低于非NEC组[-0.75（-1.58,0.03） vs.-0.17（-0.84,0.38）,P=0.01],神经发育异常发生率明显高于非NEC组（67.3%vs.35.6%,P <0.001）,DQ低于非NEC组[84(80,89)vs. 87(82,93),P=0.01]。NEC组大运动及精细运动的评分均低于非NEC组[88(77,94) vs. 92(85,96),P=0.03;89(83,96) vs...     

早产儿脑损伤与脑性瘫痪研究进展

早产儿脑损伤包括脑室周白质软化、脑室内出血和各种类型的神经源损伤,近年来随着脑室内出血(IVH)发病率的降低,脑室周白质损伤(脑室周白质软化和脑室周出血性梗死)已成为早产儿最主要的脑损伤类型,由于损伤到少突神经胶质细胞(OL),损害了髓鞘的形成和允许信号从一个轴突扩散到邻近轴突,使患儿不能适应控制肢体的位置和运动。随着NICU的发展,极低出生体重儿存活率大大提高,但神经发育后遗症并未成比例下降,其中10%左右发生脑性瘫痪(CP),25%~50%表现为轻度神经发育障碍,不仅涉及运动,也涉及到认知和行为,从而引起学习障碍。早产儿发生脑…     

早产儿早期教育对婴儿早期神经运动及智能发育的影响

目的 分析早产儿早期教育对婴儿早期神经运动及智能发育产生的影响。方法 随机选择2019年1～12月本院接诊的108例早产儿为研究对象,对照组早产儿不接受早期教育,观察组早产儿需要接受早期教育,分析两组早产儿的早期神经运动发育情况以及智能发育情况。结果 观察组早产儿在出生后6个月以及12个月智能发育情况以及早期神经运动发育情况整体优于对照组早产儿（P<0.05）。结论 通过对早产儿进行早期教育,能够有效促进早产儿早期智能的发育以及早期神经运动的发育,临床推广价值整体较高。     

极早和超早产儿神经发育结局

极早产(VPT)和超早产(EPT)儿发生脑损伤及神经发育损害的风险高。随着新生儿重症救治水平的提高,VPT和EPT早产儿存活率明显提高,如何降低神经发育损害的发生率以改善远期预后,是目前全球关注的重要问题。了解VPT和EPT早产儿神经发育预后,对指导临床救治及早期干预,改善患儿远期预后具有重要意义。     

胎盘评估早产儿脑损伤不良结局的研究进展

随着产科及新生儿重症监护技术的迅猛发展，具有极限生存活力的早产儿存活率逐年提高。但因神经系统发育不成熟，易受到各种高危因素的影响，致使脑损伤的发病率逐年上升，严重威胁早产儿的生长发育及身心健康。胎盘作为母体与胎儿连接的纽带，近年来已成为研究早产儿神经系统发育不良结局的重要器官。目前研究发现，与早产儿脑损伤有关的胎盘组织病理常伴有急性绒毛膜羊膜炎、胎盘灌注不良、绒毛膜血管病等改变；分子病理可表现为炎症因子释放增加、缺氧诱导因子过度表达与胎盘外泌体保护作用下调等变化；胎盘微小RNA（miRNAs）则可以随着宫内环境的变化而变化，反映出表观遗传调控在保护胎儿神经系统不受外来因素影响中的作用。本文从组织病理学、分子病理学及表观遗传学等方面综述早产儿胎盘的变化特点，及对神经系统发育影响的机制，以及检测早产儿胎盘对评估脑损伤不良结局的意义。     

Fenton vs. Intergrowth-21st: Postnatal Growth Assessment and Prediction of Neurodevelopment in Preterm Infants

Although the survival rate of preterm infants has improved over the years, growth failure and associated impaired neurodevelopmental outcome remains a significant morbidity. Optimal nutrition plays an important role in achieving adequate postnatal growth. Accurate growth monitoring of preterm infants is critical in guiding nutritional protocols. Currently, there is no consensus regarding which growth assessment tool is suitable for monitoring postnatal growth of preterm infants to foster optimal neurodevelopmental outcomes while avoiding future consequences of aggressive nutritional approaches including increased risk for cardiovascular disease and metabolic syndrome. A retrospective single center cohort study was conducted to compare the performance of two growth-assessment tools, Fenton and Intergrowth-21st (IG-21st) in the classification of size at birth, identification of impaired growth and predicting neurodevelopment. A total of 340 infants with mean gestational age of 30 weeks were included. Proportion of agreement between the two tools for identification of small for gestational age (SGA) was high 0.94 (0.87, 0.1) however, agreement for classification of postnatal growth failure at discharge was moderate 0.6 (0.52, 0.69). Growth failure at discharge was less prevalent using IG-21st. There was significant association between weight-based growth failure and poor neurodevelopmental outcomes at 12 and 24 months of age.     

30~34周小于胎龄儿校正18~24月龄神经发育状况的前瞻性队列研究

目的 研究30~34周小于胎龄儿(SGA)与同胎龄适于胎龄儿(AGA)校正18~24月时神经发育的差异,为临床上完善早产儿的诊疗和早期干预提供理论依据。方法 前瞻性队列研究设计,广州市妇女儿童医疗中心于2015年1月-2017年12月对高危儿门诊随访的出生胎龄30~34周高危儿病例,按胎龄与出生体重分为SGA组与AGA组,比较两组早产儿一般出生情况、围产因素、早期合并症以及校正6~12月、18~24月龄时体格增长和神经发育情况,同时分析SGA早产儿早期并发症对神经发育的影响。结果 纳入研究的随访早产儿共122例,SGA组58例,AGA组64例,两组早产儿围产及早期合并症基本情况比较,差异无统计学意义(P>0.05)。校正6~12月龄时SGA组适应性、大运动、精细运动和语言发育商比较,均低于对照组,差异有统计学意义(P<0.05),两组个人社交发育商比较,差异无统计学意义(P>0.05)。校正18~24月龄时SGA组大运动和精细运动发育商低于对照组,差异有统计学意义(P<0.05),两组适应性、语言和个人社交发育商比较,差异无统计学意义(P>0.05)。早期合并支气管肺发育不良的SGA早产儿发生神经发育迟缓(发育商≤75)比例高于对照组,差异有统计学意义(P<0.05)。结论 SGA早产儿校正18~24月龄时大运动及精细运动发育商落后于同胎龄AGA早产儿,早期合并支气管肺发育不良(BPD)可能为神经发育迟缓的潜在危险因素。     

Using Nature to Nurture: Breast Milk Analysis and Fortification to Improve Growth and Neurodevelopmental Outcomes in Preterm Infants

Premature infants are born prior to a critical window of rapid placental nutrient transfer and fetal growth—particularly brain development—that occurs during the third trimester of pregnancy. Subsequently, a large proportion of preterm neonates experience extrauterine growth failure and associated neurodevelopmental impairments. Human milk (maternal or donor breast milk) is the recommended source of enteral nutrition for preterm infants, but requires additional fortification of macronutrient, micronutrient, and energy content to meet the nutritional demands of the preterm infant in attempts at replicating in utero nutrient accretion and growth rates. Traditional standardized fortification practices that add a fixed amount of multicomponent fortifier based on assumed breast milk composition do not take into account the considerable variations in breast milk content or individual neonatal metabolism. Emerging methods of individualized fortification—including targeted and adjusted fortification—show promise in improving postnatal growth and neurodevelopmental outcomes in preterm infants.     

多学科合作的早产儿系统管理对新生儿重症监护室出院早产儿神经精神发育结局的影响

目的 分析多学科合作系统管理和早期综合干预对新生儿重症监护室(NICU)出院早产儿近期神经发育结局的影响。方法 回顾分析和比较在上海市儿童医院早产儿整合门诊接受随访的早产儿,根据管理模式分为非系统管理且无干预阶段,以及多学科合作开展系统管理阶段,比较两阶段NICU出院早产儿发育迟缓发生率;通过对照研究评价多学科合作的系统管理对NICU早产儿近期神经发育结局的影响。结果 1999年1月-2016年6月累计登记随访NICU出院早产儿997例,两阶段中早产儿随访至校正12月龄段时,系统管理下的早产儿各能区发育迟缓发生率较低(P<0.05)。对照研究表明,NICU出院早产儿接受系统管理后,校正18月龄发育商可达平均水平。结论 多学科合作开展系统的随访管理,能改善NICU出院早产儿近期神经精神发育结局。     

Severe acute malnutrition in very low birth weight preterm infants

Malnutrition in preterm low birth weight infants has adverse long-term metabolic, growth, and neurodevelopmental effects. In the past 3 decades, parenteral nutrition, enriched preterm formula, and fortification of human milk have been used to alleviate these adverse effects. Unfortified human breast milk does not provide sufficient nutrients for the growth and development of preterm infants at the volumes recommended; however, it is usually the only source of nutrition available for such infants in low-resource countries. Many newborns, including very low birth weight infants, are surviving in these countries because of concerted efforts to achieve the fourth millennium development goal. These efforts have not addressed the nutrition needs of sick preterm very low birth weight infants. The authors report 3 cases of severe acute malnutrition in very low birth weight newborns and suggest possible interventions.     

The “Fortilat” Randomized Clinical Trial Follow-Up: Neurodevelopmental Outcome at 18 Months of Age

Adequate nutrition is fundamental to neonatal survival and short-term outcomes, but it also has long-term consequences on quality of life and neurologic development of preterm infants. Donkey milk has been suggested as a valid alternative for children allergic to cows’ milk proteins, due to its biochemical similarity to human milk; we, hence, hypothesized that donkey milk could be a suitable basis for developing an innovative human milk fortifier for feeding preterm infants. The aim of the current study was to extend the findings and to evaluate the neurodevelopmental outcomes at 18 months of corrected age of the infants enrolled in the clinical trial named “Fortilat”. Infants born ≤1500 g and <32 weeks of gestational age were randomized to receive either a combination of bovine milk-based multicomponent fortifier and protein supplement or a combination of a novel multicomponent fortifier and protein supplement derived from donkey milk. The followed fortification protocol was the same for the two groups and the two diets were designed to be isoproteic and isocaloric. All infants enrolled were included in a developmental assessment program. The neurodevelopmental assessment was performed at 18 ± 6 months of corrected age. Minor and major neurodevelopmental impairment and General Quotient (GQ) at the Griffiths-II Mental Development Scale were considered. The GQ was considered both in continuous and as two classes: lower than and higher than (or equal to) a defined cutoff (GQcl). The difference in GQ and GQcl between the two arms was estimated using Mann–Whitney–Wilcoxon test or Fischer exact test, respectively, on the assumption of casual loss at follow-up. A further analysis was performed using generalized linear models. There were 103 children (bovine milk-derived fortifier arm = 54, donkey milk-derived fortifier arm = 49) included for the neurodevelopmental follow-up. All observations were included in the interval of 18 ± 6 months of corrected age. No significant difference was observed between the two arms in the incidence of neurologic sequelae and the GQs were similar in the two arms. Our results demonstrated no difference for the donkey milk-derived fortifier compared to standard bovine-derived fortifier regarding long-term neurodevelopmental outcomes.