不同时期极低和超低出生体重儿神经发育预后比较

中国儿童保健杂志 ›› 2014, Vol. 22 ›› Issue (1): 7-9.

不同时期极低和超低出生体重儿神经发育预后比较

翟倩, 曹云, 王艺, 张澜, 杨红, 邵肖梅, 徐秀, 陆春梅

复旦大学附属儿科医院, 上海 201102

收稿日期:2013-08-22 发布日期:2014-01-10 出版日期:2014-01-10
通讯作者: 曹云, E-mail:yuncaochina@hotmail.com
作者简介:翟倩(1986-), 女, 山东人, 医学硕士, 研究方向为极低和超低出生体重儿神经发育预后。
基金资助:
上海市自然科学基金重点项目(09JC1402700);NSFC-CIHR新生儿临床决策支持系统构建(中加健康研究合作计划)(81061120523)

Trends of neurodevelopmental outcomes of very low birth weight and extremely birth weight infants.

ZHAI Qian, CAO Yun, WANG Yi, ZHANG Lan, YANG Hong, SHAO Xiao-mei, XU Xiu, LU Chun-mei.

Children's Hospital of Fudan University, Shanghai 201102, China

Received:2013-08-22 Online:2014-01-10 Published:2014-01-10
Contact: CAO Yun, E-mail:yuncaochina@hotmail.com

摘要/Abstract

摘要： 目的探讨极低出生体重儿(very low birth weight infant, VLBWI)和超低出生体重儿(extremely birth weight infant, ELBWI)不同时期神经发育损害发生的变化趋势。方法复旦大学附属儿科医院新生儿科2005年10月1日-2010年12月31日收治并救治成活的VLBWI和ELBWI, 纠正胎龄18～42个月, 完成贝莉婴儿发育量表-Ⅱ(Bayley Scales of Infant Development-Ⅱ, BSID-Ⅱ)的患儿有143例, 按入院时间分为两个阶段, 第一阶段为2005年10月1日-2008年12月31日入院的患儿, 共54例;第二阶段为2009年1月1日-2010年12月31日入院的患儿, 共89例。比较两个阶段患儿的神经发育预后情况。结果两个阶段的研究对象在性别、胎龄、出生体重及分布上均相似。第一阶段患儿的智力发育指数得分(88.6±19.2)显著低于第二阶段(97.0±14.6)(P=0.004);第一阶段患儿智力发育指数<70的发生率(14.8%)显著高于第二阶段(3.4%)(P=0.014)。第一阶段患儿总体神经发育损害的发生率(22.2%)高于第二阶段(13.5%), 脑瘫发生率(9.3%)高于第二阶段(2.3%), 心理运动发育指数得分(83.6±16.1)低于第二阶段(85.0±13.6), 心理运动发育指数<70分的发生率(16.7%)高于第二阶段(12.4%), 但这几个方面的差异均无统计学意义。结论医生和家长均应重视VLBWI和ELBWI的出院后随访及早期干预, 以改善患儿的神经发育预后。

关键词: 极低出生体重儿, 超低出生体重儿, 神经发育预后, 变化趋势

Abstract: Objective To investigate changes of neurodevelopmental outcomes of very low birth weight infant (VLBWI) and extremely birth weight infant (ELBWI) occurred over the recent years. Methods The population included 143 VLBWI and ELBWI admitted from October 1^st 2005 to December 31^st 2010 who had finished the infant development test of BSID-Ⅱ at corrected gestational aged 18~42 months.The neurodevelopmental outcomes between two periods[2005-2008 (period 1);2009-2010 (period 2)]were compared. Results The subjects in two-period study were similar in gender, gestational age, and birth weight.The neurodevelopmental outcomes in period 2 improved:the MDI score was increased (97.0±14.6) versus (88.6±19.2)(P=0.004), and the rate of MDI<70 was decreased (3.4% versus 14.8%, P=0.014).In the period 1, the incidence of neurodevelopmental impairment and cerebral palsy were higher than the period 2 (22.2% versus 13.5%, 9.3% versus 2.3%), and the PDI score was lower[(83.6±16.1) versus (85.0±13.6)]and the rate of PDI<70 was higher (16.7% versus 12.4%).But these differences were not statistically significant. Conclusions Recent years, the neurodevelopmental outcomes of VLBWI and ELBWI seem to improve.Both doctors and parents should pay attention to the follow-up and early intervention of VLBWI and ELBWI after discharge, by which to improve their neurodevelopmental outcomes.

Key words: very low birth weight infant, extremely low birth weight infant, neurodevelopmental outcome, change trend

中图分类号:

R722

翟倩, 曹云, 王艺, 张澜, 杨红, 邵肖梅, 徐秀, 陆春梅. 不同时期极低和超低出生体重儿神经发育预后比较[J]. 中国儿童保健杂志, 2014, 22(1): 7-9.

ZHAI Qian, CAO Yun, WANG Yi, ZHANG Lan, YANG Hong, SHAO Xiao-mei, XU Xiu, LU Chun-mei.. Trends of neurodevelopmental outcomes of very low birth weight and extremely birth weight infants.[J]. journal1, 2014, 22(1): 7-9.

参考文献

[1] Platt MJ, Cans C, Johnson A, et al.Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres:a database study[J].Lancet, 2007, 369(9555):43-50.
[2] Doyle LW, Roberts G, Anderson PJ.Changing long-term outcomes for infants 500-999 g birth weight in Victoria, 1979-2005[J].Archives of Disease in Childhood-fetal and Neonatal Edition, 2011, 96(6):443-447.
[3] Jonsdottir GM, Georgsdottir I, Haraldsson A, et al.Survival and neurodevelopmental outcome of ELBW children at 5 years of age Comparison of two cohorts born 10 years apart[J].Acta Paediatrica, 2012, 101(7):714-718.
[4] 龚春丹, 杨红, 史惟, 等.全身运动评估和听觉诱发电位在脑瘫儿童预测中的意义[J].中国儿童保健杂志, 2011, 19(5):403-405.
[5] 杨红, 史惟, 王素娟, 等.Peabody运动发育量表在婴幼儿评估中的信度和效度研究[J].中国儿童保健杂志, 2010, 18(2):121-123.
[6] 丁艳华, 徐秀, 冯玲英, 等.贝莉婴儿发育量表-Ⅱ在我国的引进和使用初探[J].中国儿童保健杂志, 2007, 15(2):147-148.
[7] 郭书娟, 夏经炜, 曹丽娟, 等.高危儿早期干预模式的建立和评估[J].中国儿童保健杂志, 2010, 18(11):870-873.
[8] Rosenbaum P, Fau Paneth N, Leviton A, et al.A report:the definition and classification of cerebral palsy April 2006[J].Dev Med Child Neurol Suppl, 2007, 109:8-14.
[9] Bax M, Goldstein M, Rosenbaum P, et al.Proposed definition and classification of cerebral palsy, April 2005[J].Dev Med Child Neurol, 2005, 47(8):571-576.
[10] Wilson-Costello D, Friedman H, Minich N, et al.Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002[J].Pediatrics, 2007, 119(1):37-45.
[11] Moore T, Hennessy EM, Myles J, et al.Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006:the EPICure studies[J].British Medical Journal, 2012, 345:e7961.
[12] Eichenwald EC, Stark AR.Medical progress:Management and outcomes of very low birth weight[J].New England Journal of Medicine, 2008, 358(16):1700-1711.
[13] Kobaly K, Schluchter M, Minich N, et al.Outcomes of extremely low birth weight (< 1 kg) and extremely low gestational age (< 28 weeks) infants with bronchopulmonary dysplasia:Effects of practice changes in 2000 to 2003[J].Pediatrics, 2008, 121(1):73-81.
[14] 张国庆, 邵肖梅, 陆春梅, 等.NICU出院早产儿1岁时神经发育预后及干预依从性对其的影响[J].中国当代儿科杂志, 2007, 9(3):193-197.
[15] Goldstein RF.Developmental care for premature infants:a state of mind[J].Pediatrics, 2012, 129(5):1322-1323.
[16] Heidelise A, 曹云.早产儿个体化神经发育支持医护模式[J].中国循证儿科杂志, 2010, 15(4):241-244.