早期干预对早产儿智力发育的作用

目的:探讨早期干预对早产儿智力发育的作用.方法:将62例早产儿随机分为干预组30例,对照组32例,干预组自新生儿期开始干预治疗至2岁,两组早产儿均于1岁、2岁时进行智能发育检测.结果:干预组1岁、2岁时智力发育指数(MDI)和心理运动发育指数(PDI)均高于对照组,差异有统计学意义(t值分别为:1.91,2.70,2.05,2.68,P<0.05,P<0.01).结论:早期干预可促进早产儿的智力发育,有利于防治智力低下.     

早期干预对早产儿智能发育的影响

目的探讨早期干预对早产儿智能发育的影响，旨在降低其伤残率。方法将62例早产儿分为干预组（35例）和对照组（27例）。干预组早产儿出生后即提供发育支持护理，接受早期环境干预和综合康复功能训练，定期随访，对照组仅接受常规治疗及定期评估，用CDCC婴幼儿智能量表进行评估。结果6、9、12个月时干预组患儿智能发育指数（MDI）及心理运动发育指数（PDI）均优于对照组（P〈0．05）。12个月时干预组患儿智能发育指数（MDI）及心理运动发育指数（PDI）达到正常百分数85．7％，高于对照组（P〈0．05）。结论早期干预是促进早产儿智能发育的有效方法，可降低其伤残率。     

早期干预对早产儿精神运动发育的影响

目的探讨早期干预对早产儿体格、智能发育及运动发育的影响,寻找更合理的治疗流程。方法将183例早产儿列入本研究中,其中111例早产儿除接受一般育儿指导外,均进行早产儿早期干预,为干预组。72例因各种原因仅接受一般育儿指导和定期复查,为未干预组。干预组按0～2岁早期干预大纲[1]进行早期系统干预,均由同一组治疗师进行,专人进行体格发育、神经系统检查、发育商测定等。结果干预组与未干预组患儿在12月、18月时身长、体重、头围比较,差异均无显著性(P均>0.05);智力发育指数(MDI)比较:6月龄时,干预组比非干预组高4.5分,差异无显著性(P>0.05);12月龄、18月龄时干预组比未干预组分别高6.3分和7.4分,差异均有显著性(P均<0.05)。运动发育指数(PDI)比较,6月龄、12月龄、18月龄时干预组较未干预组分别高8.3分、9.3分、和11.3分,差异均有显著性(P均<0.05)。干预组脑性瘫痪、智力低下、运动低下的发生率都较未干预组低,差异均有显著性(P均<0.05)。结论早期系统干预早产儿可促进其智力和运动发育,减少脑瘫、智力低下、运动低下的发生率,应及早对早产儿进行早期系统干预治疗,提高早产儿的远期生存质量。     

早期干预对多胎早产儿体格智能发育的随访分析

目的了解早期干预对多胎早产儿体格智能发育的影响,分析其影响因素。方法本文对2001年1月～2004年7月在本院新生儿病房住院,出院后能够完成门诊随访2年的单胎早产儿165例,多胎早产儿115例,进行早期干预随访,采用Gesell婴幼儿发育检查量表测试发育商(DQ),并进行体格发育检查,分析多胎的危险因素。结果新生儿疾病如生后窒息、缺氧缺血性脑病,颅内出血,肺透明膜病,感染性疾病,高胆红素血症的患病率多胎明显高于单胎(P<0.05)。DQ低下发生率多胎组与单胎组相比,差异有显著意义(P<0.001)。2岁随访多胎早产儿在体格发育和智能发育方面均明显落后于单胎早产儿(P<0.001)。结论多胎早产儿在婴幼儿期体格智能发育落后的发生率高,且致残率高,而且与围生期的高危因素密切相关。早期干预可促进多胎儿智能及运动发育。     

早期干预高危儿的神经行为测定及对智力发育的影响

目的通过对围产期高危儿进行早期干预,使其大脑功能得到代偿,从而促进智力发育。方法采用神经行为测定（NBNA）和视、听、触觉刺激高危儿,进行康复训练。结果早期干预组与未干预组NBNA评分差异有显著性（P〈0.01）,干预组与未干预组5大能区行为发育商（DQ）比较,差异非常显著（P〈0.01）,而干预组与对照组比较无统计学差异。结论早期干预可促进高危儿的智能发育,使其尽早地康复,赶上正常儿童。     

对早产儿早期干预效果评价方法应用的研究

目的 对早产儿采取各种干预措施后,应用新生儿20项神经行为测定(BANA)和Bayley婴幼儿发育量表(BSID)对干预效果进行评价. 方法 对40名早产儿采取早期干预措施,同时设45名早产儿及47名正常足月儿两组对照组,对所有婴儿(早产儿需纠正胎龄至40周)在不同时期进行BANA、BSID 的测定.结果 两组早产儿体格智力发育均落后于正常足月儿组,但在1岁时早期干预组已接近于正常足月儿组,两组早产儿之间差异显著.结论 早期干预措施能显著促进早产儿智力体格发育;使用NABA和BSID能对干预效果进行良好的评价.     

早期干预对早产儿智能影响的研究

目的：研究早期干预对早产儿的智能发育的影响。方法：将60名早产儿分为两组,一组接受培训中心有关早期干预的措施称早产儿干预组,另一组为早产儿对照组。另将30名足月健康儿作为正常对照组,三组小儿及家长均参加定期的常规儿童保健门诊检查和指导,并均于1岁和1岁半时采用张家健等0－4岁小儿发育诊断量表评定发育商（DQ）。结果：早产儿干预组和正常对照组的DQ无差别（P＞0．05）,这两组DQ都明显高于早产儿对照组（P＜0．01）。两组早产儿1岁半时的DQ均较1岁时提高（P＜0．01）,正常对照组则提高不明显（P＞0．05）,说明早产儿在1岁至1岁半期间明发展较足月健康儿快。此外,早产儿有2例智能低下（DQ＜70）,早产儿干预组则没有。结论：早期干预可有效地促进早产儿的智能发育。     

早期干预对先天性甲状腺低下症智力发育影响

目的探讨早期干预对先天性甲状腺功能低下症患儿的智力影响.方法随机将122例先天性甲状腺功能低下症病人,分为干预组62例和对照组60例.两组病人均给以L-甲状腺素治疗.干预组采用早期干预系统进行指导.结果干预组智能商在24个月和36个月时,明显高于对照组(P＜0.01).结论早期干预能促使先天性甲状腺功能低下症的智能发育,是一种必不可少的治疗的手段.     

早产儿早期干预的预后影响研究分析

目的探讨对早产儿早期干预的预后影响。方法根据《0～3岁早期干预大纲》进行干预和指导，对105例早产儿随机分为干预组55例，对照组50例，观察早产儿生后2周内呼吸、心率、吸吮能力的影响及其婴儿2岁时智力和精神运动发育情况、心理卫生及行为问题调查、后遗症发生率的影响。结果干预组出生2周内呼吸、心率、吸吮能力较对照组强（P〈0．01），2岁时智力和精神运动发育指数、心理卫生及行为问题均高于对照组，后遗症发生率低于对照组（P〈0．05）。结论早产儿通过早期干预，可有效提高生命质量，促进智能和神经、心理、体格发育。     

260例脑性瘫痪的病因诊断和临床分析

目的研究脑性瘫痪的主要病因和早期临床表现。方法将260例脑瘫患几分为足月儿组和早产儿组，对两组患儿进行神经系统检查并进行智测，分析其病因及早期临床表现及头颅CT征象，对其高危因素和临床表现进行比较。结果足月儿组和早产儿组脑瘫患儿的病因和早期临床表现及头颅CT征象均不相同。结论对有高危因素的早产儿和足月儿，及时发现其早期异常临床表现与神经症状，作出早期诊断，以便早期干预，将脑瘫患儿神经系统后遗症减轻到最低水平。     

早产儿血小板减少症与母亲胎盘病理特点的关系

目的:探讨早产儿血小板减少症与母亲胎盘病理特点的关系.方法:纳入2015年1月1日至12月31日在广州医科大学附属广东省妇儿医院娩出并入住新生儿重症监护室(neonatal intensive care unit,NICU)72 h内血小板计数小于100×109个/L的单胎早产新生儿(出生胎龄＜37周)作为实验组,并按胎龄匹配纳入同期分娩的血小板计数正常的单胎早产新生儿作为对照组.对胎儿血栓性血管病变(fetal thrombotic vasculopathy,FTV)、胎盘梗塞性病变、脐带扭转、胎盘组织学炎性浸润等胎盘病理特点进行回顾性研究,并对所得数据进行统计学分析.结果:实验组(106例)和对照组(198例)出生胎龄分别为(31.74±2.10)和(31.92±2.06)周,差异无统计学意义(p＞0.05).对照组早产新生儿出生体重[(1 763.59±429.36)g]高于实验组[(1 659.72±422.21)g],差异有统计学意义(P＜0.0s).实验组合并胎盘功能不全情况比例(先兆子痫17.9％,胎儿宫内生长迟缓9.4％)高于对照组(先兆子痫6.1％,胎儿宫内生长迟缓2.5％),差异有统计学意义(P＜0.05).两组胎盘重量[(381.98±107.10)g和(397.05±114.28)g]比较,差异无统计学意义(P＞0.05).实验组FTV的比例(23.6％)及胎盘梗死性改变的比例(35.8％)均高于对照组(分别为12.1％和16.7％),差异均有统计学意义(P＜0.05).实验组脐带扭转及胎盘组织学炎性浸润的比例与对照组比较,差异无统计学意义(P＞0.05).结论:早产新生儿血小板减少症与胎盘梗死性改变及FTV有关,与单纯的胎盘组织炎性浸润情况无关.     

Incidence,risk factors,and adverse outcomes of acute kidney injury in very premature neonates: a single center experience

Background/aim Acute kidney injury (AKI) is a serious morbidity in premature neonates. The aim of this study was to determine the incidence of AKI and to evaluate its impact on morbidity and mortality in very premature infants.Materials and methodsThis retrospective cohort study was conducted in the neonatal intensive care unit (NICU). A total of 410 preterm infants who were born before 32 gestational weeks were screened and 318 were included in this analysis. AKI was defined according to the modified neonatal Kidney Disease: Improving Global Outcomes criteria.ResultsThe incidence of AKI was 32.1% (102/318). Regression analyses revealed that lower gestational age, vasopressor use, and hemodynamically significant patent ductus arteriosus were significantly associated with an increased risk for AKI. After adjustment for potential confounders, those with AKI had a higher risk of death before 36 weeks of corrected gestational age (adjusted hazard ratio: 3.02, 95% confidence interval 1.47– 6.22). Additionally, the AKI group had a higher rate of bronchopulmonary dysplasia (BPD) (46% vs. 24%, p < 0.001) and longer hospital stay with a mean difference of 38 days.ConclusionAKI is common in very premature neonates and associated with higher mortality, longer hospital stay, and BPD. Identification of risk factors and preventive strategies for AKI may improve the outcomes in this vulnerable population.     

早产儿血清维生素D水平与智能发育的相关性研究

目的探讨早产儿维生素D(vitamin D,VitD)水平与智能发育的相关性。方法选取我院2017年1月至2018年1月收治的685例早产儿开展回顾性分析,以出生后24h内血清25-羟维生素D[25-hydroxyvitamin D,25(OH)D]水平≥所有早产儿的平均水平为高水平组,血清25(OH)D水平<所有早产儿的平均水平为低水平组,比较两组的一般临床资料、维生素D情况,评估两组的智力发育水平;依据早产儿胎龄不同分为极早早产儿组(<28周)和常规早产儿组(28~32周),比较两组的DST及BSID评分,采用Pearson相关性分析血清25(OH)D水平与智能水平之间的相关性。结果纳入685例早产儿的血清25(OH)D水平为56.59±15.43nmol/L,高水平组365例,血清25(OH)D水平为83.41±12.64nmol/L,低水平组320例,血清25(OH)D水平为38.42±13.22nmol/L;高水平组的MDI、PDI及DQ、MI评分显著高于低水平组(P<0.05);经相关性分析,血清25(OH)D水平与MDI、PDI及DQ、MI均呈正相关(P<0.05)。结论早产儿维生素D水平与其智力发育水平呈正相关,其能促进神经发育,提高智力水平。     

新生儿先天性甲状腺功能异常发病率与胎龄、出生体重关系的研究

目的探讨广西地区先天性甲状腺功能异常（包括先天性甲状腺功能减低症（CH）和高TSH血症）发病率与胎龄、出生体重的关系。方法对2009年9月～2010年12月广西新生儿疾病筛查中心筛查的新生儿,凡滤纸血促甲状腺素（TSH）〉8.0mIU/L者予以召回,进行甲状腺功能检查。结果 2009年9月～2010年12月共筛查220 844人,确诊先天性甲状腺功能异常200人,发病率为1/1104。其中,早产儿（胎龄〈37周）发病率为1/449,足月儿（37≤胎龄≤42周）发病率为1/1189,过期产儿（胎龄〉42周）发病率为1/206,过期产儿发病率高于早产儿及足月产儿（P〈0.05）。低出生体重儿﹙〈2500g）发病率为1/407,正常体重儿（2500～4000g）发病率为1/1236,巨大儿（〉4000g）发病率为1/376,低出生体重儿及巨大儿的先天性甲状腺功能异常发病率明显高于正常体重儿（P〈0.01）。结论先天性甲状腺功能异常的发病率与胎龄、出生体重密切相关,过期产儿、巨大儿、低出生体重儿的发病率较高。注意孕期保健防止过期产儿、巨大儿、低出生体重儿,对降低先天性甲状腺功能异常的发生有重大意义。     

Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with Family Nurture Intervention in the NICU

Preterm delivery can precipitate maternal psychological morbidities. Family Nurture Intervention (FNI) was designed to minimize these by facilitating the emotional connection between mother and infant, beginning early in the infant’s neonatal intensive care unit (NICU) stay. We examined depression and anxiety symptoms of mothers of preterm infants at 4 months infant corrected age (CA). One hundred fifteen mothers who delivered between 26 and 34 weeks gestational age were randomized to receive standard care (SC) or standard care plus FNI. Mothers’ self-reported depressive symptoms (Center for Epidemiologic Studies Depression Scale: CES-D) and state anxiety (Spielberger State-Trait Anxiety Inventory: STAI) symptoms were assessed at enrollment, near to term age, and 4 months (CA). At 4 months CA, mean CES-D and STAI scores were significantly lower in FNI mothers compared to SC mothers. Effectiveness of FNI can only be evaluated as an integrated intervention strategy as it was not possible to control all aspects of FNI activities. Although there was considerable loss to follow-up, analyses suggest that resulting biases could have masked rather than inflated the measured effect size for depressive symptoms. FNI may be a feasible and practicable way to diminish the impact of premature delivery on maternal depressive and anxiety symptoms.     

早期干预对早产低出生体重儿行为发展影响的研究

目的：探讨早期干预对早产低出生体重儿行为发展的作用。方法：采用自行设计的一套早期干预方法通过指导家长对实验组实施，另设对照组，用Gesell婴幼儿发展检查量表测出两组早产低出生体重儿不同阶段的行为发展商（PQ）并作比较，1岁时与正常新生儿相比较。结果：1岁时实验组各行为能区的DQ均大于对照组存在统计学差异，与正常新生儿对照组无统计学差异，与正常新生儿的实验组相比仅在语言上无统计学差异。而对照组各行为能区的DQ与正常新生儿实验组和对照组都有明显的统计学差异。结论：早期干预能促进早产低出生体重儿早期的行为发展，帮助他们尽早地康复，赶上正常儿童。     

Non-nutritive sucking evaluation in preterm newborns and the start of oral feeding: a multicenter study

OBJECTIVES:

The assessment of early sucking by preterm infants provides information on the ability of these infants to efficiently and safely receive nutrients via an oral route (oral feeding). To analyze the application and reliability of an instrument in assessing non-nutritive sucking that indicates a capacity for oral feeding in the routine care of different neonatal units.

METHODS:

A multicenter, prospective cohort study was conducted in seven neonatal units. A non-nutritive sucking assessment with a formulary validated by Neiva et al (2008) (variables evaluated: rooting reaction; easy initiation of sucking; labial sealing; tongue central groove; peristaltic tongue movements; jaw raising and lowering movements; labial, tongue and jaw coordination; sucking strength; sucking rhythm; bites; excessive jaw excursion; stress signals) was applied to 199 pre-term newborns, who had a chronological age ≥ 2 days and were clinically stable. These infants were divided into two groups based on their corrected gestational age at the first assessment, as follows: Group I-infants with a gestational age ≤ 33 weeks and Group II-infants with a gestational age between 34 and 36 6/7 weeks.

RESULTS:

The mean gestational age was 31.66±2 weeks, and the mean birth weight was 1494 ± 373 g. The mean scores on the non-nutritive sucking assessment were 46 ± 25 in Group I and 49 ± 24 in Group II. The beginning of oral feeding was successful in 43 (67.2%) infants in Group I and 64 (81%) infants in Group II (p = 0.089).

CONCLUSION:

The method identified preterm infants who were able to feed orally based on 33 points in the non-nutritive sucking assessment and a corrected gestational age of 32 weeks or more. The corrected gestational age was the most important factor in predicting the success of oral feeding.