不同出生胎龄婴幼儿期神经行为发育水平研究

目的探讨不同出生胎龄婴幼儿神经行为发育水平差异。方法采用随机抽样的方法抽取2019年1月1日至2020年6月30日在西北妇女儿童医院出生的新生儿作为研究对象,按照出生胎龄分为早产儿组(胎龄28~36周)、早期儿组(胎龄37~38周)、足月儿组(胎龄≥39周)。早产儿与早期儿于纠正胎龄40周、足月儿于生后24 h进行新生儿神经行为评分(NBNA);分别在早产儿、早期儿、足月儿生后6个月、12个月、24个月时随访,采用北京首都儿童研究所《0~6岁儿童神经心理发育量表》评估其进行神经心理发育水平。结果本次研究共纳入986名新生儿,早产儿组122例,其中男54例,女68例,平均胎龄(32.42±1.54)周;早期儿组275例,其中男122例,女153例,平均胎龄(37.54±1.21)周;足月儿组589人,其中男245人,女344人,平均胎龄(39.89±0.52)周。6月龄时,早产儿组、早期儿组总发育商以及大运动、精细运动、认知、语言、社会交往5方面评分均显著低于足月儿组(均P<0.01)。12月龄时、24月龄时,早产儿组总发育商以及大运动、精细运动、认知、语言、社会交往5方面评分均显著低于足月儿组(均P<0.01)。胎龄与大运动、精细运动、认知、语言、社会交往评分呈正相关(均P<0.05),胎龄越大,大运动、精细运动、认知、语言、社会交往评分越高(r=0.992、0.968、0.955、0.933、0.990)。结论出生后早产儿组以及早期儿组儿童神经行为发育水平均显著低于足月儿,6月龄时早产儿组以及早期儿组儿童神经心理发育水平均显著低于足月儿组,在12月龄与24月龄时早产儿神经心理发育水平仍旧显著低于足月儿组,但早期儿与足月儿神经心理发育水平相当。

Study on neurobehavioral development of children of different birth and gestational ages

Objective To explore the difference of neurobehavioral development among children of different birth and gestational ages. Methods Neonates born in Northwest Women's and Children's Hospital from January 1, 2019 to June 30, 2020 were selected by random sampling method, and were divided into premature infants group （gestational age 28-36 weeks）, early infants group （gestational age 37-38 weeks）, and term infants group （gestational age ≥ 39 weeks） according to gestational age. Neonatal Behavioral Neurological Assessment （NBNA） was performed in premature and early infants at 40 weeks of corrected gestational age and in term infants at 24 hours after birth. At 6 months, 12 months, and 24 months after birth, premature infants, early infants, and term infants were followed up to evaluate their neuropsychological development level using the Neuropsychological Development Scale for Children Aged 0-6 from Beijing Capital Children's Research Institute. Results There were 986 newborns in this study. There were 122 premature infants, including 54 males and 68 females, with an average gestational age of （32.42 ± 1.54） weeks; 275 early infants, including 122 males and 153 females, with an average gestational age of （37.54 ± 1.21） weeks; 589 term infants, including 245 males and 344 females, with an average gestational age of （39.89 ± 0.52） weeks. At the age of 6 months, the scores of total development quotient, gross motor, fine motor, cognition, language, and social interaction in premature infants and early infants were significantly lower than those in term infants （all P<0.01）. At the age of 12 months and 24 months, the scores of total development quotient, gross motor, fine motor, cognition, language, and social interaction in premature infants were significantly lower than those in term infants （all P<0.01）. The gestational age was positively correlated with the scores of gross motor, fine motor, cognition, language, and social interaction （all P<0.05）. The older the gestational age was, the higher the scores of gross motor, fine motor, cognition, language, and social interaction were （r=0.992, 0.968, 0.955, 0.933, 0.990）. Conclusions The neurobehavioral development levels of postnatal premature infants and early infants are significantly lower than that of term infants. The neuropsychological development levels of 6-month-old premature infants and early infants are significantly lower than that of term infants. The neuropsychological development levels of 12-month-old and 24-month-old premature infants are still significantly lower than that of term infants, but the early infants are equivalent to that of term infants.