上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2023 , Vol. 43 >Issue 4: 445 - 452

DOI: https://doi.org/10.3969/j.issn.1674-8115.2023.04.006

论著 · 临床研究

早中期早产儿校正18月龄神经发育状况和影响因素

  • 沈力 ,
  • 黄亨烨 ,
  • 于广军
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  • 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
沈 力（1995—），女，博士生；电子信箱：shenli_0510@126.com。
于广军，电子信箱：gjyu@shchildren.com.cn。
黄亨烨，电子信箱：hengyehuang@sjtu.edu.cn

收稿日期: 2022-11-12

  录用日期: 2023-03-14

  网络出版日期: 2023-04-28

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)

收起

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

  • Li SHEN ,
  • Hengye HUANG ,
  • Guangjun YU
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  • 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
YU Guangjun, E-mail: gjyu@shchildren.com.cn.
HUANG Hengye, E-mail: hengyehuang@sjtu.edu.cn

Received date: 2022-11-12

  Accepted date: 2023-03-14

  Online published: 2023-04-28

Supported by

Clinical Research Plan of Shanghai Hospital Development Center for Multi-Center Clinical Research of Major Diseases(SHDC2020CR1047B)

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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

本文引用格式

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 . DOI: 10.3969/j.issn.1674-8115.2023.04.006

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

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