先天性心脏病儿童神经心理发育状况及影响因素研究

doi:10.11852/zgetbjzz2022-0547

中国儿童保健杂志 ›› 2022, Vol. 30 ›› Issue (10): 1078-1082.DOI: 10.11852/zgetbjzz2022-0547

先天性心脏病儿童神经心理发育状况及影响因素研究

王若思, 周锦妍, 汪艳, 张俊霞, 李丛梅, 李晶, 冯燕, 杨舒

昆明医科大学附属延安医院预防保健科,云南昆明 650051

收稿日期:2022-05-05 修回日期:2022-08-17 发布日期:2022-10-14 出版日期:2022-10-10
作者简介:王若思(1988-),女,云南人,主治医师,硕士学位,主要研究方向为特殊健康状态儿童管理。
基金资助:
昆明市卫生健康委员会卫生科研课题项目(2020-12-03-011);昆明医科大学附属延安医院院内课题(yyky019-046)

Current status of neuropsychological development and its influencing factors in children with congenital heart disease

WANG Ruo-si, ZHOU Jin-yan, WANG Yan, ZHANG Jun-xia, LI Cong-mei, LI Jing, FENG Yan, YANG Shu

Department of Preventive Healthcare,Yan'an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan 650051, China

Received:2022-05-05 Revised:2022-08-17 Online:2022-10-10 Published:2022-10-14
Contact: YANG Shu, E-mail:yangshu_2021@163.com

摘要/Abstract

摘要： 目的分析先天性心脏病(CHD)儿童的神经心理发育状况及影响因素,为促进CHD儿童神经心理发育提供科学依据。方法采用1:1病例对照研究方法,按相同月龄、性别、地区进行配对。选取2019年1月—2021年12月在昆明医科大学附属延安医院预防保健科进行儿童保健的符合条件348对12~36月龄的儿童为研究对象。采用面对面方式进行统一问卷调查,收集社会人口学特征及相关信息,应用“0～6岁儿童发育筛查测验”(DST)对儿童神经心理发育状况进行筛查。比较病例组和对照组儿童神经心理发育的状况,分析影响CHD儿童发育的因素。结果 CHD组发育商(DQ)、智力指数(MI)均低于对照组(P＜0.001),房间隔缺损组神经心理发育优于其他类型CHD儿童。多因素有序多分类Logistic回归分析显示:男性(OR=4.505,95%CI:1.717～17.241)、早产(OR=9.091,95%CI:1.538～47.121)、独生子女(OR=3.802,95%CI:1.051～13.889)是CHD儿童DQ落后的危险因素,母亲工作类型为弹性时间工作(OR=0.118,95%CI:0.029～0.487)、定期儿童保健(OR=0.233,95%CI:0.098～0.553)可降低CHD儿童DQ异常的风险;早产(OR=3.906,95%CI:1.346～11.364)是CHD儿童MI落后的危险因素,母亲工作类型为弹性时间工作(OR=0.219,95%CI:0.052～0.923)、定期儿童保健(OR=0.224,95%CI:0.089～0.560)可降低MI异常的风险。结论 CHD儿童神经心理发育水平仍不理想,需进一步研究和干预并制定适合我国CHD儿童的评估和治疗标准。

关键词: 先天性心脏病, 神经心理发育, 儿童

Abstract: Objective To investigate the current situation and related influencing factors of neuropsychological development in children with congenital heart disease (CHD), so as to provide scientific basis for enhancing the neuropsychological development. Methods A 1:1 case-control study was designed matched by age, gender and residential type. From January 2019 to December 2021, a total of 348 pairs of infants aged 12 to 36 months were enrolled in this study from the Department of Preventive Healthcare, Yan'an Hospital Affiliated to Kunming Medical University. Cases and controls were interviewed face to face with a uniformed questionnaire to collect their socio-demographic data. Developmental Screening Test (DST) for children under six was used to conduct neuropsychological test among these children. The neuropsychological development status of children in the two groups was compared. Factors related to the neuropsychological development of children with CHD were then analyzed. Results The scores of development quotient (DQ) and mental index (MI) among children with CHD were lower than those in the control group (P＜0.001). The neuropsychological development of children with atrial septal defect was better than that of children with other types of CHD. Multivariate Logistic regression analysis showed that male children (OR=4.505, 95%CI:1.171 - 17.241), premature (OR=9.091, 95%CI: 1.538 - 47.121) and only children (OR=3.802, 95%CI: 1.051 - 13.889) were risk factors for delayed DQ of CHD children, while flexible working arrangement of mothers (OR=0.118, 95%CI: 0.029 - 0.487), regular healthcare (OR=0.233, 95%CI: 0.098 - 0.553) were associated with lower risk of DQ retardation. Premature (OR=3.906, 95%CI: 1.346 - 11.364) were significantly associated with MI delays, while flexible working arrangement of mothers (OR=0.219, 95%CI: 0.052 - 0.923), regular healthcare (OR=0.224, 95%CI: 0.089 - 0.560) were related to lower risk of MI retardation. Conclusions The neuropsychological development of CHD children is still unsatisfactory. Further studies are warranted in order to make neurodevelopmental evaluation strategies for children with CHD.

Key words: congenital heart disease, neuropsychological development, children

中图分类号:

R725.4

王若思, 周锦妍, 汪艳, 张俊霞, 李丛梅, 李晶, 冯燕, 杨舒. 先天性心脏病儿童神经心理发育状况及影响因素研究[J]. 中国儿童保健杂志, 2022, 30(10): 1078-1082.

WANG Ruo-si, ZHOU Jin-yan, WANG Yan, ZHANG Jun-xia, LI Cong-mei, LI Jing, FENG Yan, YANG Shu. Current status of neuropsychological development and its influencing factors in children with congenital heart disease[J]. Chinese Journal of Child Health Care, 2022, 30(10): 1078-1082.

参考文献

[1] Ribera I, Ruiz A, Sánchez O, et al. Multicenter prospective clinical study to evaluate children short-term neurodevelopmental outcome in congenital heart disease (children NEURO-HEART):Study protocol[J]. BMC Pediatr, 2019, 19(1):326.
[2] Lawley CM, Winlaw DS, Sholler GF, et al. School-age developmental and educational outcomes following cardiac procedures in the first year of life:A population-based record linkage study[J]. Pediatr Cardiol, 2019, 40(3):570-579.
[3] Liamlahi R, Latal B. Neurodevelopmental outcome of children with congenital heart disease[J]. Handb Clin Neurol, 2019, 162:329-345.
[4] Fourdain S, St-Denis A, Harvey J, et al. Language development in children with congenital heart disease aged 12-24 months[J]. Eur J Paediatr Neurol, 2019, 23(3):491-499.
[5] Ware J, Butcher JL,Latal B, et al. Neurodevelopmental evaluation strategies for children with congenital heart disease aged birth through 5 years:Recommendations from the cardiac neurodevelopmental outcome collaborative[J]. Cardiol Young, 2020, 30(11): 1609-1622.
[6] Zhong J, He Y, Gao J, et al. Parenting knowledge, parental investments, and early childhood development in rural households in Western China[J]. Int J Environ Res Public Health, 2020, 17(8):2792.
[7] deOnis M, Onyango AW, Borghi E, et al. Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO international growth reference:Implications for child health programmes [J]. Public Health Nutr, 2006, 9(7):942-947.
[8] 郑慕时,冯玲英,刘湘云,等. 0～6岁儿童智能发育筛查测验全国城市常模的制定[J].中华儿科杂志,1997,35(3):117.
[9] Marino BS,Lipkin PH, Newburger JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management[J]. Circulation, 2012, 126:1143-1172.
[10] White BR, Rogers LS,Kirschen MP. Recent advances in our understanding of neurodevelopmental outcomes in congenital heart disease[J]. Curr Opin Pediatr, 2019, 31(6):783-788.
[11] Ryan KR, Jones MB, Allen KY, et al. Neurodevelopmental outcomes among children with congenital heart disease: At-risk populations and modifiable risk factors[J]. World J Pediatr Congenit Heart Surg, 2019, 10(6):750-758.
[12] Pappas A,Shankaran S, Hansen NI, et al. Outcome of extremely preterm infants (<1,000 g) with congenital heart defects from the National Institute of Child Health and Human Development Neonatal Research Network[J]. Pediatr Cardiol, 2012, 33(8):1415-1426.
[13] 赵乾龙,李晶,李福轮,等.先天性心脏病婴儿体格发育及精神发育状况[J].中国妇幼保健,2018,33(16):3746-3749.
[14] 桂娟,何少茹,孙云霞,等.先天性心脏病小婴儿18月龄时神经发育障碍及影响因素研究[J].中华胸心血管外科杂志,2019,35(10):577-582.
[15] 杜鸿昌,王华春,陈淑静.介入术与开胸术对室间隔缺损患儿认知及心理行为能力的影响[J].河北医药,2018,40(7):1046-1050.
[16] Warnes CA, Liberthson R, Danielson GK, et al. Task force 1: the changing profile of congenital heart disease in adult life[J]. J Am Coll Cardiol, 2001, 37(5):1170-1175.
[17] Marino BS,Lipkin PH, Newburger JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management:A scientific statement from the American Heart Association[J]. Circulation,2012, 126(9):1143-1172.
[18] 杨舒,张俊霞,王若思.昆明市6～36月龄婴幼儿神经心理发育现状及其影响因素研究 [J].中国儿童保健杂志,2019,27(4):425-428.
[19] Müller M,Tronick E, Zietlow AL, et al. Effects of maternal anxiety disorders on infant self-comforting behaviors: The role of maternal bonding, infant gender and age[J]. Psychopathology, 2016, 49(4):295-304.
[20] Foret JT, Dekhtyar M, Cole JH, et al. Network modeling sex differences in brain integrity and metabolic health[J]. Front Aging Neurosci, 2021, 13:691691.
[21] Tanner K, Sabrine N. Cardiovascular malformations among preterm infants[J].Christopher Wren Pediatrics, 2005, 116 (6):833-838.
[22] Boat TF, Kelleher KJ. Fostering healthy mental, emotional, and behavioral development in child health care[J]. JAMA Pediatr, 2020, 174(8):745-746.
[23] 李小艳,张丽,刘锦蕾.儿童保健干预促进婴幼儿早期生长智力及运动发育的作用分析[J].山西医药杂志,2020,49(4):382-384.
[24] 王燕,陈桂花,董菊.强化保健对婴幼儿生长发育及营养性疾病发生率的干预效果分析[J].新疆医科大学学报,2019,42(4):547-550.

先天性心脏病儿童神经心理发育状况及影响因素研究

Current status of neuropsychological development and its influencing factors in children with congenital heart disease

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