早期干预对早产小于胎龄儿体格发育及神经心理发育的影响

目的研究在新生儿重症监护病房(NICU)住院期间及出院后行早期干预对早产小于胎龄儿的体格发育及神经心理发育的影响,为早产高危儿的干预提供参考。方法选取2016年10月-2019年2月在温州市中西医结合医院NICU住院的早产小于胎龄儿做为观察组(n=103),分别在住院期间及出院后给予早期干预,将此前在本院住院的早产小于胎龄儿但并未实行早期干预措施的患儿做为对照组(n=89),记录两组患儿体格发育指标,并于关键年龄行0~1岁20项神经运动评估(INMA)及贝利婴幼儿发育(BSIDⅡ)评估,将两组患儿上述检查指标进行对照分析。结果观察组和对照组矫正年龄6、12月龄时,体重、身长比较差异无统计学意义,但12月龄时两组间头围比较差异有统计学意义(t=-2.260,P=0.032)。矫正年龄18月龄时,体重、身长及头围在两组间比较差异均有统计学意义(t=-2.652,-3.381,-2.627,P<0.05)。矫正年龄6月龄时体重及头围的追赶率观察组较对照组高(χ~2=3.891、4.444,P<0.05),矫正年龄18月龄身长的追赶率观察组亦较对照组高,差异有统计学意义(χ~2=4.516,P=0.034);矫正年龄6月龄前行INMA提示观察组矫正年龄4月、5月时INMA异常率较对照组低(χ~2=4.401、4.786,P<0.05),矫正年龄12月龄及18月龄时运动发展指数(PDI)及智力发育指数(MDI)比较观察组均明显高于对照组(t=2.645、3.492、2.427、2.437,P<0.05)。结论对早产小于胎龄儿进行早期干预,可以促进其体格发育及神经心理发育,有利于早期实现追赶生长,减少神经系统后遗症,实现此类高危儿健康生长轨迹的发展。

Effect of early intervention program on physical and neuropsychological development in premature small for gestational age infants

Objective To study the effect of early intervention on physical and neuropsychological development of preterm small for gestational age infants(SGA)during hospitalization and after discharge in Neonatal Intensive Care Unit(NICU), in order to provide reference for the intervention of preterm high-risk infants. Methods Preterm SGAs hospitalized in NICU from October 2016 to February 2019 were enrolled in observation group (n=103), who received early intervention during hospitalization and after discharge.And those hospitalized in this hospital but did not took early intervention measures were selected as control group (n=89).Physical development indexes of the two groups were recorded.The 20 items of neuromotor assessment at 0-1 year old(INMA) and the Bailey Infant Development scale(BISDⅡ)were used for assessment at the critical age, and the results were compared between the two groups. Results At the corrected age of 6 and 12 months, there was no significant difference on body weight and length.However, there was significant difference on head circumference between observation group and control group at the corrected age of 12 months (t=-2.260, P=0.032).At the age of 18 months, there were significant differences on body weight, body length and head circumference between the two groups (t=-2.652, -3.381, -2.627, P<0.05).The catch-up growth rates of body weight and head circumference in observation group were significantly higher than those in control group at the corrected age of 6 months (χ²=3.891, 4.444, P＜0.05).And the catch-up growth rate of body length in observation group was also higher than that in control group (χ²=4.516, P=0.034).INMA results indicated that abnormal rate of observation group was lower than that of control group (χ²=4.401, 4.786, P<0.05).Moreover, the psychomotor development index (PDI) and the mental development index (MDI) in observation group were significantly higher than those in control group at the corrected age of 12 months and 18 months(t=2.645, 3.492, 2.427, 2.437, P＜0.05). Conclusion Early intervention for premature SGAs can promote their physical and neuropsychological development, facilitate early catch-up growth, reduce neurological sequelae, thereby achieving the development of healthy growth tracks of this kind of high-risk children.