序贯化发育干预对出生胎龄34周及以前早产儿早期神经运动发育的影响

Effect of sequential developmental intervention on early neuromotor development in preterm infants born with gestational age ≤34 weeks

摘要

目的 探讨序贯化发育干预计划对出生胎龄≤34周早产儿早期神经运动发育的影响。方法 回顾性分析2018年10月至2022年2月在南通大学附属江阴医院新生儿重症监护室(NICU)住院并在该院和江阴市妇幼保健院儿童保健门诊建立健康档案随访至校正6月龄的120例出生胎龄≤34周早产儿的临床资料.根据不同干预方法将其分为观察组(60例)和对照组(60例).对照组采用常规发育干预:在NICU住院期间采用母乳或早产儿配方奶粉喂养,未进行初乳口腔护理、口腔运动干预、袋鼠护理相关措施,出院后按常规发育规律进行门诊随访指导训练.观察组采用序贯化发育干预:在NICU住院期间采用母乳或早产儿配方奶粉喂养的基础上进行初乳口腔护理、口腔运动干预、袋鼠护理相关措施,出院后复诊时按计划进行全身运动质量评估(GMs)及20项神经运动检查,根据检查结果指导个体化家庭干预.采用0~6岁儿童发育行为评估量表对两组早产儿校正6月龄的发育商结果进行评估。结果 两组早产儿出生胎龄、出生体重、出生身长、出生头围,以及性别、宫内发育迟缓、胎膜早破、剖宫产、母亲妊娠期糖尿病、多胎、重度窒息、中重度支气管肺发育不良、颅内出血(Ⅲ~Ⅳ级)、有创机械通气的分布比较差异均无统计学意义(P＞0．05).校正6月龄,观察组早产儿发育商评分明显高于对照组[(79．36±7．12)分vs．(75．96±6．93)分,t＝2．647,P＜0．05],其中两组的大运动[(86．93±9．06)分vs．(83．67±8．31)分]、精细运动[(80．44±7．46)分vs．(76．63±7．86)分]、适应能力[(76．81±8．39)分vs．(71．95±10．98)分]、社会行为[(76．09±9．01)分vs．(72．68±6．93)分]评分均明显高于对照组(t值分别为2．052、2．725、2．722、2．316,P＜0．05),而两组的语言评分比较差异无统计学意义[(77．31±9．50)分vs．(74．84±9．45)分,t＝1．423,P＞0．05)].校正6月龄,两组早产儿的体重、身长比较差异均无统计学意义(P＞0．05),但观察组头围发育较对照组更好[(42．88±0．74)cm vs．(42．58±0．85)cm,t＝2．117,P＜0．05]。结论 序贯化发育干预有助于促进早产儿早期大运动、精细运动、适应能力及社会行为的发育,对于改善小孕周早产儿神经运动发育预后有重要意义,其在基层医院早产儿儿童保健实施中具有推广意义.

Abstract

Objective To investigate the effect of sequential developmental intervention programme on early neuromotor development of preterm infants born with gestational age ≤34 weeks. Methods The clinical data of 120 cases of preterm infants with birth gestational age ≤34 weeks that were hospitalised in the neonatal intensive care unit (NICU) of Jiangyin Hospital affiliated of Nantong University from October 2018 to February 2022 and had their health records established in the child health clinic of the hospital and Jiangyin Maternal and Child Health Care Hospital for follow up until the corrected age of 6 months were retrospectively analysed. According to the intervention method, they were divided into the observation group (60 cases) and the control group (60 cases). The control group applied conventional developmental intervention: breastfeeding or preterm infant formula feeding was used during hospitalisation in the NICU without colostrum oral care, oral motor intervention, kangaroo care related measures, and outpatient follow-up guidance and training were conducted according to conventional developmental patterns after discharge. The observation group applied sequential developmental interventions: colostrum oral care, oral motor interventions, and kangaroo care related measures based on breastfeeding or preterm formula feeding during the hospitalisation in the NICU, and general movements (GMs) and 20-item neuromotor examination at the follow-up visit after the hospital discharge as planned, and individualized family interventions were guided based on the results of the examination. The development quotient results of the two groups of preterm infants at the age of 6 months were evaluated with the Child Neuropsychological Development Scale. Results There was no statistically significant difference between the two groups when comparing the birth gestational age, birth weight, birth length, birth head circumference of preterm infants, as well as the distribution of gender, intrauterine growth retardation, preterm rupture of membranes, cesarean section, gestational diabetes mellitus of the mother, multiple births, severe asphyxia, moderately severe bronchopulmonary dysplasia, intracranial haemorrhage (grades III-IV), and invasive mechanical ventilation (all P＞0．05). At the age of 6 months after correction, the growth quotient points of preterm infants in observation group were significantly higher than those in control group [(79．36±7．12) points vs. (75．96±6．93) points, t＝2．647, P＝0．01), in which gross motor [(86．93±9．06) points vs. (83．67±8．31) points], fine motor [(80．44±7．46) points vs. (76．63±7．86) points], adaptive ability [(76．81±8．39) points vs. (71．95±10．98) points], and social behaviour [(76．09±9．01) points vs. (72．68±6．93) points] points were significantly higher than those in control group (t＝2．052, 2．725, 2．722, 2．316, respectively, P＜0．05), whereas there was no statistically significant difference in speech scores between the two groups [(77．31±9．50) points vs. (74．84±9．45) points, t＝1．423, P＞0．05)]. Corrected for 6 months of age, there was no statistically significant difference in the comparison of weight and length between the two groups of preterm infants (all P＞0．05), but the head circumference development was better in the observation group than in the control group [(42．88±0．74) cm vs. (42．58±0．85) cm, t＝2．117, P＜0．05]. Conclusion Sequential developmental intervention is helpful to promote the development of early gross motor, fine motor, adaptive ability and social behaviour of preterm infants, which is important for improving the prognosis of neuromotor development of preterm infants at small gestational weeks, and it has significance for the implementation of child healthcare for preterm infants in primary hospitals.

关键词

序贯化发育干预 / 早产儿 / 0~6岁儿童发育行为评估量表 / 神经运动发育

Key words

sequential development intervention / preterm infants / developmental behavioural assessment scale for children aged 0-6 years / neuromotor development

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基金资助

江阴市科技创新专项基金(JY0603ＧA021014Ｇ210014ＧPB)

江阴市中青年卫生后备优秀人才资助项目(JYROYT202304)