NBNA评分在评价早产儿脑发育、脑损伤及预后中的应用

目的 评估20项新生儿行为神经测定(NBNA)对评价早产儿脑发育、脑损伤及预后的价值。方法 选择2012年1月-2013年12月郑州市儿童医院、西安交通大学第一附属医院新生儿科收治并经NBNA评分的早产儿397例,分为高危异常表现组(HRAN组)206例、高危正常表现组(HRN组)108例、“正常”组(N组)83例,比较三组NBNA评分及NBNA评分与发育商(DQ)的关系。结果 三组早产儿的NBNA评分随评分日龄增长呈递增趋势,增幅随胎龄增加呈递减趋势,各组NBNA评分增加幅度依次为HRN组、N组、HRAN组(P<0.05)。校正胎龄<37周时,HRAN组、HRN组、N组NBNA评分均<36分;校正胎龄≥37周时,HRAN组评分<36分,HRN组评分>36分,N组评分>37分。校正胎龄37周NBNA评分≤35分早产儿的智力发育落后比例高于NBNA评分>35分者,差异有统计学意义(P<0.01)。结论 NBNA评分可用于反映早产儿脑发育状况及发展规律,并与神经发育预后有关,连续性评分对评价早产儿脑损伤更有意义。

Evaluation of brain development and injury in preterm infants by neonatal behavioral neurological assessment

Objectives To analyze the neonatal behavioral neurological assessment (NBNA) score in the evaluation of brain development,brain injury and prognostic in preterm infants. Methods The research was performed on 397 preterm infants who performed NBNA from January 2012 to December 2013 at the neonatal intensive care unit in Zhengzhou Children's Hospital and the First Affiliated Hospital of Xi'an Jiaotong University,divided into high-risk abnormal group (group HRAN,n=206),high-risk normal group (group HRN,n=108),the "normal" group (group N,n=83),the difference of NBNA score was compared among three groups,and the effect of NBNA score in assessing prognosis was analyzed. Results With the rising of the assessment time,NBNA score showed an increasing tread in three groups,and there was a deceleration trend with the GA grouping.The increasing of NBNA score was group HRN >group N> group HRAN (P<0.05).NBNA scores in the three groups were lower than 36 points when GA corrected to preterm;When the GA corrected to term,NBNA score was lower than 36 points in group HRAN,higher than 36 points in group HRN,and higher than 37 points in group N.The mental retardation children with NBNA score less than 35 points were more when the GA corrected was to 37 weeks,there were significant statistical difference(P<0.01). Conclusion NBNA score can be used to reflect the condition and discipline of brain development in preterm infants,and it has relationship with the outcome of brain development.