小于胎龄儿早期脑发育及18~24月龄时神经发育状况的前瞻性队列研究

doi:10.11852/zgetbjzz2022-0729

摘要/Abstract

摘要： 目的探讨小于胎龄(SGA)儿生后早期脑发育状况及18~24月龄时神经发育水平,为临床上完善SGA的诊疗及早期干预提供参考依据。方法选择 2019年1月—2020年12月在濮阳市妇幼保健院出生,且出院后定期在儿童保健门诊随访的病例为研究对象,按胎龄及出生体重分为早产SGA组、早产适于胎龄(AGA)组、足月SGA组和足月AGA组,比较4组出生后24~48h内头颅超声测量胼胝体长度、胼胝体-顶点长度、小脑蚓部高度和小脑蚓部前后径值,以及校正胎龄18~24月龄时神经发育水平,同时分析SGA对神经发育的影响。结果 4组间小脑蚓部高度差异有统计学意义(F=5.214,P<0.05),其中早产SGA、早产AGA和足月SGA组小脑蚓部高度均落后于足月AGA组,且早产SGA组落后于早产AGA和足月SGA组(P<0.05);4组间18~24月龄时适应性(F=10.152)、大运动(F=16.842)、精细动作(F=5.256)、语言(F=12.387)和个人社交发育商(F=7.963)差异均有统计学意义(P＜0.05),其中早产SGA组语言和个人社交发育较早产AGA组落后,且适应性、大运动、精细动作、语言和个人社交发育均落后于足月AGA,而足月SGA组大运动和语言发育落后于足月AGA组。与足月AGA组相比,早产SGA组大运动(OR=2.895, 95%CI:1.896~5.691)和语言发育(OR=4.026,95%CI: 1.124~13.264)落后风险增加(P<0.05),而足月SGA大运动发育落后的风险增加(OR=1.259, 95%CI:1.084~2.169,P<0.05)。结论 SGA儿生后可能出现脑发育异常,且在18~24月龄时神经发育水平落后于AGA儿,即便是足月SGA儿同样存在神经发育异常的高风险,临床应重视其随访管理及早期干预。

关键词: 小于胎龄儿, 脑发育, 神经行为发育, 随访, 早期干预

Abstract: Objective To investigate the postnatal brain development and neurdevelopment at the age of 18 to 24 months in small gestational age (SGA) infants, in order to provide reference for follow-up and early intervention of SGA. Methods Neonates born in Puyang Maternal and Child Health Hospital from January 2019 to December 2020 and regularly followed up in the child health care clinic after discharge were selected as study subjects.According to gestational age and birth weight, neonates were divided into four groups: Premature SGA, premature appropriate gestational age (AGA), full-term SGA and full-term AGA.Cranial ultrasound was used to measure the corpus callosum length, corpus callosum-fastigium length, cerebellar vermis height, and cerebellar vermis anteroposterior diameter of the neonates within 24 to 48 hours.The neurdevelopment at the age of 18 to 24 months was assessed, and the effect of SGA on neurdevelopment was analyzed. Results There were statistically significant differences in vermis height between the four groups (F=5.214, P<0.05).The vermis height of premature SGA, premature AGA and full-term SGA infants were all lower than that of full-term AGA infants, which was higher inpreterm AGA and full-term SGA infants than preterm SGA infants.There were statistically significant differences in adaptability (F=10.152), gross motor(F=16.842), fine motor(F=5.256), language(F=12.387) and personal social development quotient(DQ) (F=7.963) between the four groups at 18 to 24 months of age (P<0.05).The language and personal social DQ of premature SGA infants was lower that of premature AGA infants, and the adaptation, gross motor, fine motor, language and personal social development were behind that of full-term AGA infants.However,full-term SGA laged behind full-term AGA in gross motor and language development.Compared with full-term AGA, premature SGA had an increasing risk of gross motor (OR=2.895, 95%CI:1.896 - 5.691, P<0.05) and language development retardation (OR=4.026, 95%CI:1.124 - 13.264, P<0.05), while full-term SGA had an increasing risk of gross motor development retardation(OR=1.259, 95%CI:1.084 - 2.169, P<0.05). Conclusions SGA may have abnormal brain development after birth, and the neurdevelopment at the age of 18 to 24 months lags behind AGA, and even full-term SGA are at a high risk of abnormal neurdevelopment.Therefore, clinical attention should be paid to the follow-up management and early intervention of SGA.

Key words: small for gestational age, brain development, neurdevelopment, follow-up, early intervention

中图分类号:

R174

王晓庆, 刘九月, 姚光. 小于胎龄儿早期脑发育及18~24月龄时神经发育状况的前瞻性队列研究[J]. 中国儿童保健杂志, 2023, 31(4): 353-358.

WANG Xiaoqing, LIU Jiuyue, YAO Guang. Prospective cohort study on postnatal brain development and neurdevelopmental outcomes at the age of 18 to 24 months in small for gestational age infants[J]. Chinese Journal of Child Health Care, 2023, 31(4): 353-358.

参考文献

[1] Lee AC, Kozuki N, Cousens S, et al.Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21(st) standard:Analysis of CHERG datasets[J].BMJ,2017,358:j3677.
[2] Nam HK, Lee KH.Small for gestational age and obesity:Epidemiology and general risks[J].Ann Pediatr Endocrinol Metab,2018,23(1):9-13.
[3] 王庆红,杨于嘉,魏克伦,等.我国小于胎龄儿现状分析[J].中国实用儿科杂志,2009,24(3):177-180.
Wang QH, Yang YJ, Wei KL,et al.Current situation investigation and analysis of SGA in China[J].Chinese Journal of Practical Pediatrics,2009,24(3):177-180.
[4] Ray JG, Park AL, Fell DB.Mortality in infants affected by preterm birth and severe small-for-gestational age birth weight[J].Pediatrics,2017,140(6):e20171881.
[5] Stewart B, Karahalios A, Pszczola R, et al.Moderate to late preterm intrauterine growth restriction: A restrospective, observational study of the indications for delivery and outcomes in an Australian perinatal centre[J].Australian and New Zealand Journal of Obstetrics and Gynaecology,2018,58(3):306-314.
[6] Aldana-Aguirre JC, Toye J, Shah PS, et al.Patent ductus arteriosus and small for gestational age infants: Treatment approaches and outcomes[J].Early Hum Dev,2019,131:10-14.
[7] Chauhan SP, Rice MM, Grobman WA, et al.Neonatal morbidity of small-and large-for-gestational-age neonates born at term in uncomplicated pregnancies[J].Obstet Gynecol,2017,130(3):511-519.
[8] Padilla N, Falcon C, Sanz-Cortes M, et al.Differential effects of intrauterine growth restriction on brain structure and development in preterm infants:A magnetic resonance imaging study[J].Brain Res,2011,1382:98-108.
[9] Girsen AI, Do SC, El-Sayed YY, et al.Association between small-for-gestational age and neurocognitive impairment at two years of corrected age among infants born at preterm gestational ages:A cohort study[J].J Perinatol,2017,37(8):958-962.
[10] Jensen RB, Juul A, Larsen T, et al.Cognitive ability in adolescents born small for gestational age: Associations with fetal growth velocity, head circumference and postnatal growth[J].Early Hum Dev,2015,91(12):755-760.
[11] Bickle Graz M, Tolsa J, Fischer Fumeaux CJ.Being small for gestational age: Does it matter for the neurodevelopment of premature infants? A cohort study[J].PLoS One,2015,10(5):e125769.
[12] Murki S, Kallem VR, Gururaj J, et al.Growth and neurodevelopmental outcomes at 12 to 18 months of corrected age in preterm infants born small for gestational age[J].Indian Pediatr,2020,57(4):301-304.
[13] Christian P.Fetal growth restriction and preterm as determinants of child growth in the first two years and potential interventions[J].Nestle Nutr Inst Workshop Ser,2014,78:81-91.
[14] Wada N, Funabiki K, Nakanishi S.Role of granule-cell transmission in memory trace of cerebellum-dependent optokinetic motor learning[J].Proc Natl Acad Sci U S A,2014,111(14):5373-5378.
[15] 侯留杰,栗河舟,吴娟,等.颅脑超声评估宫内生长受限对新生儿脑发育的影响[J].中国医学影像学杂志,2022,30(3):261-265.
Hou LJ, Li HZ, Wu J,et al.Cranial ultrasound study on the effect of intrauterine growth restriction on neonatal brain development[J].Chinese Journal of Medical Imaging,2022,30(3):261-265.
[16] 王影,李桂芳,刘瑞可,等.适于胎龄儿和小于胎龄儿小脑发育的对比研究[J].中国当代儿科杂志,2020,22(9):936-941.
Wang Y, Li GF, Liu RK,et al.A comparative study of cerebellar development between appropriate-for-gestational age infants and small-for-gestational-age infants[J].Chinese Journal of Contemporary Pediatrics,2020,22(9):936-941.
[17] 翁梅倩,张伟利,敖黎明,等.小于胎龄儿脑发育的随访观察[J].中华围产医学杂志,2001,4(2):88-91.
Weng MQ, Zhang WL, Ao LM, et al.Follow-up on the development of the brain in small for gestational age infants[J].Chinese Journal of Perinatal Medicine,2001,4(2):88-91.
[18] Murki S, Kallem VR, Gururaj J, et al.Growth and neurodevelopmental outcomes at 12 to 18 months of corrected age in preterm infants born small for gestational age[J].Indian Pediatr,2020,57(4):301-304.
[19] Kato T, Mandai T, Iwatani S, et al.Extremely preterm infants small for gestational age are at risk for motor impairment at3 years corrected age[J].Brain and Development,2016,38(2):188-195.
[20] Castro CJ, Gonzalez CC, Gonzalez GN, et al.Assessment of neonatal EEG background and neurodevelopment in full-term small for their gestational age infants[J].Pediatr Res,2020,88(1):91-99.
[21] Takeuchi A, Yorifuji T, Takahashi K, et al.Neurodevelopment in full-term small for gestational age infants: A nationwide Japanese population-based study[J].Brain Dev,2016,38(6):529-537.
[22] Heinonen K, Raikkonen K, Pesonen AK, et al.Behavioural symptoms of attention deficit/hyperactivity disorder in preterm and term children born small and appropriate for gestational age:A longitudinal study[J].BMC Pediatr,2010,10:91.
[23] Eves R, Mendonca M, Bartmann P, et al.Small for gestational age-cognitive performance from infancy to adulthood: an observational study[J].BJOG,2020,127(13):1598-1606.
[24] 游晶玉,苏喆,潘丽丽.小于胎龄儿的研究进展[J].中国实用儿科杂志,2021,36(8):602-607.
You JY, Su Z, Pan LL.Research progress in small for gestational age[J].Chinese Journal of Practical Pediatrics,2021,36(8):602-607.