不同出生胎龄低出生体重儿2岁内神经心理发育纵向随访研究

目的 分析不同出生胎龄的低出生体重儿(LBWI)2岁内神经心理发育规律,为开展针对性的早期干预提供依据。方法 将2016年1月—2017年2月出生、在上海闵行完成2岁内随访的280名LBWI分为早期早产儿组(胎龄28~33⁺⁶周,EPT)、晚期早产儿组(胎龄34~36⁺⁶周,LPT)和足月儿组(胎龄37~41⁺⁶周,T),采用全身运动(GMs)评估及Gesell量表随访至2岁。结果 6月龄内GMs异常检出率:在“早产/扭动”阶段,胎龄越小组越高(χ²=7.36,P＜0.05); “不安运动”阶段组间无差异(χ²=4.36,P＞0.05);9、18和24月龄[(生后(9±1)月、(18±2)月、(24±3)月]3次Gesell监测显示: 除EPT 组的9月龄5个能区与18月龄“言语能和应人能”外,其余月龄能区均达正常水平(DQ≥86);除24月龄的“言语和应人能”外,其余月龄能区DQ在胎龄越小组越低(P＜0.05);“发育落后”(DQ＜86)检出率仅在9月龄的5个能区和18月龄的“精细动作、应人能和应物能”表现为胎龄越小组越高(P＜0.01);多元线性回归分析显示,校正了儿童、父母以及家庭的多个混杂因素后,除24月龄的“应人能”外,其余月龄能区与胎龄均呈显著正相关(β:0.612~2.382,P＜0.01)。结论 出生胎龄是影响LBWI2岁内神经心理发育的重要因素,胎龄越小组发育越差;早产儿在2岁内呈发育追赶趋势,至2岁时平均可达到正常水平,但在粗大与精细动作及应物能的发育仍落后于足月儿;应重视LBWI尤其合并有早产者早期系统保健,以实现发育落后儿的早发现、个性化早干预,促进其早期合理追赶与均衡发展。

Longitudinal follow-up study on neuropsychiatric development of low birth weight infants at different gestational ages within two years old

Objective To analyze the neuropsychological development of low birth weight infants (LBWI) with different gestational ages within the age of two years, so as to provide basis for targeted early intervention. Methods From January 2016 to February 2017, a total of 280 low birth weight infants (LBWI) who completed neuropsychological development follow-up within the age of two years in Minhang District of Shanghai were collected. According to gestational age, children were divided into three groups: early preterm (28-33⁺⁶ weeks, EPT), late preterm (34-36⁺⁶ weeks, LPT) and term infants (37-41⁺⁶ weeks, T). General movements(GMs) assessment and Gesell scale were adopted to evaluate the children′s neurobehavioral development. Results The abnormal rate of GMs in preterm birth or torsion stage was found higherin the lower gestational age group (χ²=7.36,P＜0.05), while no significant difference existed in the restless movement stageamong EPT group, LPT group and T group(χ²=4.36, P>0.05). Gesell results indicated that except for the five domains at 9 months old and the language, individual-social domains at 18 months old in EPT group, all of the development quotient (DQ) of the five domains of Gesell scale reached the normal level(DQ≥86). The DQ of the five domains scored lower in the lower gestational age group (P<0.05), except for the domains of language and individual-social at 24 months old. The higher rate of developmental delay(DQ＜86) was found in the lower gestational age group, with statistically significant difference among EPT group, LPT group and T group in the five domains at 9 months old and in the domains of fine motor, adaptability and individual-social at 18 months old (P<0.01). Multiple linear regression analysis indicated that a significantly positively correlation existed between gestational age and the DQ of all the domains in different age groupsexcept for the domain of individual-social at 24 months oldafter adjustment for confounding factors, including children, parents and families(β: 0.612-2.382, P<0.01). Conclusions Gestational age at birth is an important and independent factor for the neuropsychological development of LBWI within 2 years old, and children with lower gestational age have the worse development. Preterm infants have a catch-up in neuropsychological development, which can reach the normal level until 2 years old. But the DQ of the domains of gross motor, fine motor and adaptability are still lower than the full-term infants. Thus it is supposed to strengthen the early systematic healthcare of LBWI, especially for the preterm children, in order to realize the early detection and personalized intervention of the developmental delay and to promote the early reasonable catch-up and all-around balanced development.