早中期早产儿校正18月龄神经发育状况和影响因素

doi:10.3969/j.issn.1674-8115.2023.04.006

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (4): 445-452.doi: 10.3969/j.issn.1674-8115.2023.04.006

• 论著 · 临床研究 • 上一篇

早中期早产儿校正18月龄神经发育状况和影响因素

沈力¹^,²(), 黄亨烨¹(), 于广军³()

^1.上海交通大学公共卫生学院，上海 200025
^2.上海交通大学医学院附属第六人民医院临床研究中心，上海 200233
^3.上海市儿童医院，上海交通大学医学院附属儿童医院儿童精准医学工程技术研究中心，上海 200040

收稿日期:2022-11-12 接受日期:2023-03-14 出版日期:2023-04-28 发布日期:2023-04-28
通讯作者: 黄亨烨,于广军 E-mail:shenli_0510@126.com;hengyehuang@sjtu.edu.cn;gjyu@shchildren.com.cn
作者简介:沈力（1995—），女，博士生；电子信箱：shenli_0510@126.com。
基金资助:
上海申康医院发展中心重大疾病多中心临床研究(SHDC2020CR1047B)

Current status of neurodevelopmental outcomes and its influencing factors of early-to-moderate preterm infants at corrected age of 18 months

SHEN Li¹^,²(), HUANG Hengye¹(), YU Guangjun³()

^1.Shanghai Jiao Tong University School of Public Health, Shanghai 200025, China
^2.Clinical Research Center, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
^3.Children's Precision Medicine Engineering Technology Research Center, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200040, China

Received:2022-11-12 Accepted:2023-03-14 Online:2023-04-28 Published:2023-04-28
Contact: HUANG Hengye,YU Guangjun E-mail:shenli_0510@126.com;hengyehuang@sjtu.edu.cn;gjyu@shchildren.com.cn
Supported by:
Clinical Research Plan of Shanghai Hospital Development Center for Multi-Center Clinical Research of Major Diseases(SHDC2020CR1047B)

摘要/Abstract

摘要：

目的·了解出生胎龄≤34周的早中期早产儿在校正月龄18个月时的神经发育状况并分析其影响因素。方法·选取2013年1月—2020年4月在上海市儿童医院重症监护中心住院，并在出院后进行规律随访的早中期产儿作为研究对象。收集早产儿及其父母的人口学特征和临床相关资料。根据校正月龄18个月时的格塞尔发育量表（Gesell Development Schedule，GDS）结果，将早产儿分为神经发育正常组和神经发育迟缓组。比较2组在早产儿基本人口学特征、出生情况、父母亲基本人口学特征和产检情况方面的差异，采用逐步Logistic回归探讨早产儿神经发育迟缓的影响因素。结果·共调查了929例早产儿，其中男童527例（56.7%）、女童402例（43.3%），平均胎龄为（31.06±2.23）周，极早早产儿138例（14.9%）。在校正月龄18个月时，发生神经发育迟缓共147例（15.8%），在粗动作能、细动作能、言语能、应物能和应人能的异常率分别为7.4%、9.7%、17.9%、14.2%和13.7%。对神经发育迟缓组和正常组的临床特征进行比较发现，性别、是否为极早早产儿、出生体质量、分娩方式和是否发生宫内窘迫在2组间的差异有统计学意义（均P<0.05）。逐步Logistic回归分析的结果显示，男童（OR=1.60，95%CI 1.05~2.44，P=0.028）、剖宫产分娩（OR=1.67，95%CI 1.08~2.60，P=0.022）、极早早产儿（OR=2.20，95%CI 1.34~3.62，P=0.002）和发生宫内窘迫（OR=5.03，95%CI 2.11~11.99，P=0.000）是早中期早产儿神经发育迟缓的危险因素。结论·男童、极早早产儿、剖宫产分娩和发生宫内窘迫的早中期早产儿发生神经发育迟缓的可能性较高，应重点关注和加强这类早产儿的随访管理。

关键词: 早产儿, 神经发育, 神经发育迟缓, 危险因素, 格塞尔发育量表

Abstract:

Objective ·To analyze the neurodevelopmental outcomes and risk factors of early-to-moderate preterm infants with gestational age≤34 weeks at corrected age of 18 months. Methods ·The early-to-moderate preterm infants hospitalized in Neonatal Intensive Care Unit of Shanghai Children's Hospital from January 2013 to April 2020, and regularly followed up after discharge were included in this study. Demographic and clinically relevant data of preterm infants and their parents were collected. The infants were divided into the neurodevelopmental retardation group and the normal neurodevelopment group according to their Gesell Development Schedule (GDS) scores at corrected age of 18 months. The demographic characteristics of preterm infants, birth status, demographic characteristics of parents and prenatal examinations between the two groups were compared, and stepwise Logistic regression was used to explore the factors influencing neurodevelopmental outcomes in preterm infants. Results ·A total of 929 preterm infants were included in the study, including 527 boys (56.7%) and 402 girls (43.3%), with a mean gestational age of (31.06±2.23) weeks and 138 (14.9%) extremely preterm infants. A total of 147 infants (15.8%) had neurodevelopmental retardation of early-to-moderate preterm infants at corrected age of 18 months, with abnormalities of 7.4%, 9.7%, 17.9%, 14.2% and 13.7% in gross motor, fine motor, language, adaptive behavior and personal-social behavior, respectively. A comparison of the clinical characteristics between the neurodevelopmental retardation group and the normal neurodevelopment group revealed statistically significant differences in terms of gender, whether the baby was an extremely preterm infant, birth weight, mode of delivery, and occurrence of intrauterine distress (all P<0.05). Stepwise Logistic regression analysis showed that boys (OR=1.60, 95%CI 1.05?2.44, P=0.028), cesarean section (OR=1.67, 95%CI 1.08?2.60, P=0.022), extremely preterm infants (OR=2.20, 95%CI 1.34?3.62, P=0.002) and intrauterine distress (OR=5.03, 95%CI 2.11?11.99, P=0.000) were the risk factors for neurodevelopmental retardation. Conclusion ·Boys, extremely preterm infants, cesarean section and intrauterine distress may increase the neurodevelopmental retardation risk of early-to-moderate preterm infants and improving follow-up management of these preterm infants should be focused on and enhanced.

Key words: preterm infant, neurodevelopment, neurodevelopmental retardation, risk factor, Gesell Development Schedule

中图分类号:

R722.6

沈力, 黄亨烨, 于广军. 早中期早产儿校正18月龄神经发育状况和影响因素[J]. 上海交通大学学报（医学版）, 2023, 43(4): 445-452.

SHEN Li, HUANG Hengye, YU Guangjun. Current status of neurodevelopmental outcomes and its influencing factors of early-to-moderate preterm infants at corrected age of 18 months[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(4): 445-452.

图/表 5

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Variable	Total (n=929)	Normal neurodevelopment group (n=782)	Neurodevelopmental retardation group (n=147)	t/z/χ² value	P value
Gender/n(%)				8.023	0.005
Boy	527 (56.7)	428 (54.7)	99 (67.3)
Girl	402 (43.3)	354 (45.3)	48 (32.7)
Gestational age/week	31.06±2.23	31.10±2.18	30.81±2.46	1.211	0.140
Extremely preterm infant/n(%)	138 (14.9)	107 (13.7)	31 (21.1)	5.365	0.021
Birth weight/kg	1.61 (1.32, 1.91)	1.64 (1.35, 1.93)	1.50 (1.24, 1.80)	2.412	0.016
Birth weight/n(%)				3.518	0.172
Normal birth weight	40 (4.3)	33 (4.2)	7 (4.8)
Low birth weight	439 (47.3)	381 (48.7)	58 (39.5)
Extremely low birth weight	303 (32.6)	248 (31.7)	55 (37.4)
Missing	147 (15.8)	120 (15.3)	27 (18.4)
Body length/cm	42.0 (39.0, 44.8)	42.0 (39.0, 45.0)	42.0 (38.0, 44.0)	1.298	0.194
Delivery mode/n(%)				13.211	0.000
Vaginal delivery	709 (76.3)	614 (78.5)	95 (64.6)
Cesarean delivery	220 (23.7)	168 (21.5)	52 (35.4)
Intrauterine distress/n(%)	24 (2.6)	13 (1.7)	11 (7.5)	16.658	0.000
Respiratory failure of newborn/n(%)	237 (25.5)	191 (24.4)	46 (31.3)	3.071	0.080
Apnea of newborn/n(%)	83 (8.9)	70 (9.0)	13 (8.8)	0.002	0.966
Pneumonia of newborn/n(%)	308 (33.2)	260 (33.2)	48 (32.7)	0.020	0.888
Purulent meningitis of newborn/n(%)	40 (4.3)	35 (4.5)	5 (3.4)	0.347	0.556
Hyperbilirubinemia of newborn/n(%)	447 (48.1)	374 (47.8)	73 (49.7)	0.167	0.683

Variable	Total (n=929)	Normal neurodevelopment group (n=782)	Neurodevelopmental retardation group (n=147)	t/z/χ² value	P value
Gender/n(%)				8.023	0.005
Boy	527 (56.7)	428 (54.7)	99 (67.3)
Girl	402 (43.3)	354 (45.3)	48 (32.7)
Gestational age/week	31.06±2.23	31.10±2.18	30.81±2.46	1.211	0.140
Extremely preterm infant/n(%)	138 (14.9)	107 (13.7)	31 (21.1)	5.365	0.021
Birth weight/kg	1.61 (1.32, 1.91)	1.64 (1.35, 1.93)	1.50 (1.24, 1.80)	2.412	0.016
Birth weight/n(%)				3.518	0.172
Normal birth weight	40 (4.3)	33 (4.2)	7 (4.8)
Low birth weight	439 (47.3)	381 (48.7)	58 (39.5)
Extremely low birth weight	303 (32.6)	248 (31.7)	55 (37.4)
Missing	147 (15.8)	120 (15.3)	27 (18.4)
Body length/cm	42.0 (39.0, 44.8)	42.0 (39.0, 45.0)	42.0 (38.0, 44.0)	1.298	0.194
Delivery mode/n(%)				13.211	0.000
Vaginal delivery	709 (76.3)	614 (78.5)	95 (64.6)
Cesarean delivery	220 (23.7)	168 (21.5)	52 (35.4)
Intrauterine distress/n(%)	24 (2.6)	13 (1.7)	11 (7.5)	16.658	0.000
Respiratory failure of newborn/n(%)	237 (25.5)	191 (24.4)	46 (31.3)	3.071	0.080
Apnea of newborn/n(%)	83 (8.9)	70 (9.0)	13 (8.8)	0.002	0.966
Pneumonia of newborn/n(%)	308 (33.2)	260 (33.2)	48 (32.7)	0.020	0.888
Purulent meningitis of newborn/n(%)	40 (4.3)	35 (4.5)	5 (3.4)	0.347	0.556
Hyperbilirubinemia of newborn/n(%)	447 (48.1)	374 (47.8)	73 (49.7)	0.167	0.683

Variable	Total (n=929)	Normal neurodevelopment group (n=782)	Neurodevelopmental retardation group (n=147)	z/χ² value	P value
Maternal age/year	31.0 (28.0, 34.0)	31.0 (28.0, 34.0)	31.0 (28.0, 34.0)	0.161	0.872
Parental smoking^①/n(%)	179 (19.3)	145 (18.5)	34 (23.1)	1.674	0.196
Maternal alcohol consumption/n(%)	4 (0.4)	4 (0.5)	0 (0)	0.755	0.855
Father's chronic illness/n(%)	33 (3.6)	25 (3.2)	8 (5.4)	1.821	0.177
Mother's chronic illness/n(%)	43 (4.6)	34 (4.3)	9 (6.1)	0.883	0.347
Gestational hypertension/n(%)	48 (5.2)	37 (4.7)	11 (7.5)	1.912	0.167
Gestational diabetes mellitus/n(%)	95 (10.2)	76 (9.7)	19 (12.9)	1.386	0.239
Thyroid disease during pregnancy/n(%)	44 (4.7)	33 (4.2)	11 (7.5)	2.920	0.087
Anemia during pregnancy/n(%)	36 (3.9)	27 (3.5)	9 (6.1)	2.368	0.124
Placenta previa/n(%)	15 (1.6)	14 (1.8)	1 (0.7)	0.388	0.533
Abruptio placentae/n(%)	9 (1.0)	9 (1.2)	0 (0)	0.719	0.396
Abnormal fetal position/n(%)	5 (0.5)	5 (0.6)	0 (0)	0.128	0.721
Number of prenatal tests≥8/n(%)	363 (39.1)	307 (39.3)	56 (38.1)	0.070	0.791
Tertiary hospital maternity examination/n(%)	401 (43.2)	331 (42.3)	70 (47.6)	1.412	0.235

Variable	Total (n=929)	Normal neurodevelopment group (n=782)	Neurodevelopmental retardation group (n=147)	z/χ² value	P value
Maternal age/year	31.0 (28.0, 34.0)	31.0 (28.0, 34.0)	31.0 (28.0, 34.0)	0.161	0.872
Parental smoking^①/n(%)	179 (19.3)	145 (18.5)	34 (23.1)	1.674	0.196
Maternal alcohol consumption/n(%)	4 (0.4)	4 (0.5)	0 (0)	0.755	0.855
Father's chronic illness/n(%)	33 (3.6)	25 (3.2)	8 (5.4)	1.821	0.177
Mother's chronic illness/n(%)	43 (4.6)	34 (4.3)	9 (6.1)	0.883	0.347
Gestational hypertension/n(%)	48 (5.2)	37 (4.7)	11 (7.5)	1.912	0.167
Gestational diabetes mellitus/n(%)	95 (10.2)	76 (9.7)	19 (12.9)	1.386	0.239
Thyroid disease during pregnancy/n(%)	44 (4.7)	33 (4.2)	11 (7.5)	2.920	0.087
Anemia during pregnancy/n(%)	36 (3.9)	27 (3.5)	9 (6.1)	2.368	0.124
Placenta previa/n(%)	15 (1.6)	14 (1.8)	1 (0.7)	0.388	0.533
Abruptio placentae/n(%)	9 (1.0)	9 (1.2)	0 (0)	0.719	0.396
Abnormal fetal position/n(%)	5 (0.5)	5 (0.6)	0 (0)	0.128	0.721
Number of prenatal tests≥8/n(%)	363 (39.1)	307 (39.3)	56 (38.1)	0.070	0.791
Tertiary hospital maternity examination/n(%)	401 (43.2)	331 (42.3)	70 (47.6)	1.412	0.235

Abnormality	Total (n=929)	Normal neurodevelopment group (n=782)	Neurodevelopmental retardation group (n=147)	χ² value
Gross motor/n(%)	69 (7.4)	20 (2.6)	49 (33.3)	170.455
Fine motor/n(%)	90 (9.7)	19 (2.4)	71 (48.3)	297.568
Language/n(%)	166 (17.9)	80 (10.2)	86 (58.5)	196.481
Adaptive behavior/n(%)	132 (14.2)	33 (4.2)	99 (67.3)	404.518
Personal-social behavior/n(%)	127 (13.7)	31 (4.0)	96 (65.3)	394.527

早中期早产儿校正18月龄神经发育状况和影响因素

Current status of neurodevelopmental outcomes and its influencing factors of early-to-moderate preterm infants at corrected age of 18 months

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Metrics

Variable	B	SE	P value	OR (95%CI)
Constant	－2.37	0.20	0.000
Boys	0.47	0.21	0.028	1.60 (1.05－2.44)
Cesarean section	0.52	0.23	0.022	1.67 (1.08－2.60)
Extremely preterm infants	0.79	0.25	0.002	2.20 (1.34－3.62)
Intrauterine distress	1.62	0.44	0.000	5.03 (2.11－11.99)

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