关键词: 低出生体重, 早产, 足月, 神经心理发育, GMs评估, Gesell评估

Abstract: 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.

Key words: low birth weight, preterm, term, neuropsychological development, general movements assessment, Gesellassessment