早期干预对NICU早产儿体格及神经心理发育的效果研究

Effects of early intervention on physical and neuropsychological development in NICU preterm infants

摘要

目的 探讨早期干预对于新生儿重症监护病房(NICU)早产儿两年内的体格和神经心理发育的影响。方法 选取2018年1月至2020年12月于苏州市立医院就诊的102例NICU早产儿为干预组,随机抽取105例同期健康足月儿为对照组。结果 矫正24月龄时,经早期干预的低危早产儿体重、身长以及头围的Z评分均可达到正常足月儿水平(分别为0.34±0.98、0.40±1.30和0.54±1.04,P＞0.05),但是高危早产儿组的3项Z评分不及足月儿组(分别为-0.17±1.15、0.00±1.29和-0.33±1.24,P＜0.05).大运动方面,矫正6~24月龄,高危、低危早产儿均可达足月儿水平,24月龄时,高危儿组、低危儿组、足月儿组分别为101.81±10.05、102.06±10.85、100.47±9.40(P＞0.05).语言与社交行为方面,矫正18~24月龄,早产儿的发育水平可达足月儿水平.适应能力发育方面,矫正18月龄前,高危、低危早产儿适应能力水平可达足月儿,但24月龄时,早产儿适应能力水平均不及足月儿,高危儿组、低危儿组、足月儿组分别为102.77±12.04、101.73±10.34、106.78±9.31(P＜0.05).与之类似的精细运动发育,矫正12月龄时,高危、低危早产儿精细运动水平可达足月儿,18~24月龄时,高危、低危早产儿精细运动水平均不及足月儿。结论 出生后2年内高危和低危早产儿体格及神经心理发育存在差异,且高危早产儿落后尤其明显.正确认识早产儿体格及神经心理发育规律,制定个体化的早期干预模式,对早产儿的体格及神经心理发育具有重要作用.

Abstract

Objective To investigate the effects of early intervention on the physical and neuropsychological development of preterm infants in neonatal intensive care unit (NICU) within two years. Methods A total of 102 NICU preterm infants treated at Suzhou Municipal Hospital from January 2018 to December 2020 were selected as the intervention group, and 105 healthy full-term infants born during the same period were randomly selected as the control group. Results At 24 months of age, the Z-scores for weight, length and head circumference of low-risk preterm infants who received early intervention reached levels similar to full-term infants (0.34±0.98, 0.40±1.30 and 0.54±1.04, respectively, P＞0.05), however, the Z-scores for these measures in the high-risk preterm infants were lower compared to the full-term group (-0.17±1.15, 0.00±1.29, and -0.33±1.24, respectively, P＜0.05). In terms of gross motor development, by 6 to 24 months corrected age, both high-risk and low-risk preterm infants reached levels comparable to full-term infants. At 24 months of age, the mean scores for high-risk, low-risk and full-term infants were 101.81±10.05, 102.06±10.85, and 100.47±9.40, respectively (all P＞0.05). In terms of language and social behavior, by 18 to 24 months corrected age, the development level of preterm infants could reach the level of full-term infants. In terms of adaptive development, before 18 months corrected age, the adaptive ability of high-risk and low-risk preterm infants could reach full-term infants, however, at 24 months, the adaptive ability of preterm infants were lower than that of full-term infants, and the adaptive ability of high-risk infants, low-risk infants and full-term infants were 102.77±12.04, 101.73±10.34, 106.78±9.31, respectively (all P＜0.05). Similar trends were observed for fine motor development, at 12 months corrected age, the fine motor level of high-risk and low-risk preterm infants could reach full-term infants, and at 18 to 24 months corrected age, the fine motor level of high-risk and low-risk preterm infants were lower than full-term infants. Conclusion Within the first two years after birth, there are differences in physical and neuropsychological development between high-risk and low-risk preterm infants, with high-risk preterm infants exhibiting more pronounced delays. Understanding the physical and neuropsychological development of premature infants correctly and formulating individualized early intervention mode play a crucial role in physical and neuropsychological development of premature infants.

关键词

早产儿 / 体格发育 / 神经心理发育 / 早期干预

Key words

preterm infants / physical development / neuropsychological development / early intervention

参考文献

[1] Chawanpaiboon S, Vogel JP, Moller AB, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis[J]. Lancet Glob Health, 2019, 7(1): e37-e46.

[2] Chen C, Zhang JW, Xia HW, et al. Preterm birth in China between 2015 and 2016[J]. Am J Public Health, 2019, 109(11): 1597-1604.

[3] Schneider J, Miller SP. Preterm brain injury: white matter injury[J]. Handb Clin Neurol, 2019, 162: 155-172.

[4] 陈雪婷, 沈理笑. 早产儿精神和体格发育的影响因素及早期干预[J]. 中国儿童保健杂志, 2019, 27(12): 1324-1326.

[5] 梁晶晶, 胡艳, 邢艳菲, 等. 晚期早产儿和早期足月儿1岁时神经心理发育水平的随访研究[J]. 中国当代儿科杂志, 2020, 22(7): 706-710.

[6] 何喜宁, 刘俐, 候新芳, 等. 高危儿早期干预策略的临床研究[J]. 中国妇幼健康研究杂志, 2019, 30(3): 1129-1132.

[7] Bolk J, Farooqi A, Hafström M, et al. Developmental coordination disorder and its association with developmental comorbidities at 6.5 years in apparently healthy children born extremely preterm[J]. JAMA Pediatr, 2018, 172(8): 765-774.

[8] White SW, Newnham JP. Is it possible to safely prevent late preterm and early term births? [J]. Semin Fetal Neonatal Med, 2019, 24(1): 33-36.

[9] 章莹莹, 李菁, 盛王涛, 等. 早产儿追赶性生长随访资料回顾分析[J]. 中国儿童保健杂志, 2020, 28(6): 684-688.

[10] Cheong JL, Doyle LW, Burnett AC, et al. Association between moderate and late preterm birth and neurodevelopment and social-emotional development at age 2 years[J]. JAMA Pediatr, 2017, 171(4): e164805.

[11] Li HL, Chen LL, Qian G, et al. A birth cohort study of neurodevelopmental outcomes from birth to 2 years of age in preterm infants under 34 weeks of gestation[J]. J Healthc Eng, 2022, 2022: 7496785.

[12] Murray SR, Shenkin SD, McIntosh K, et al. Long term cognitive outcomes of early term (37-38 weeks) and late preterm (34-36 weeks) births: a systematic review[J]. Wellcome Open Res, 2017, 2: 101.

[13] 孙燕, 张瑜平, 贾文智, 等. 早期干预对早产儿认知发育的影响[J]. 中国妇幼健康研究杂志, 2019, 30(3): 275-278.

[14] 牟雨虹, 李婧, 胡幼芳. 早产儿早期神经运动干预研究进展[J]. 中国儿童保健杂志, 2022, 30(2): 181-183, 193.

[15] 王雪茵, 周敏, 张小松, 等. 374例早产儿追赶生长的纵向随访研究[J]. 中国妇幼健康研究, 2017, 28(12): 1497-1500.

[16] Lee EJ, Lee SY. The effects of early-stage neurodevelopmental treatment on the growth of premature infants in neonatal intensive care unit[J]. J Exerc Rehabil, 2018, 14(3): 523-529.

[17] 谢甜, 郝波, 周敏, 等. 家庭干预对早产儿早期神经心理发育效果研究[J]. 中国儿童保健杂志, 2017, 25(5): 452-455.

[18] Woythaler M. Neurodevelopmental outcomes of the late preterm infant[J]. Semin Fetal Neonatal Med, 2019, 24(1): 54-59.

[19] Spittle A, Orton J, Anderson PJ, et al. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants[J]. Cochrane Database Syst Rev, 2015, 2015(11): CD005495.

[20] Forbes TA, Goldstein EZ, Dupree JL, et al. Environmental enrichment ameliorates perinatal brain injury and promotes functional white matter recovery[J]. Nat Commun, 2020, 11(1): 964.

[21] Marks KP. AAP developmental surveillance and screening algorithm is improved but further discussion needed about 24 months and 4 years[J]. Pediatrics, 2020, 145(6): e20200712A.

[22] 中国优生优育协会婴幼儿发育专业委员会. 高危新生儿行为神经发育早期干预专家共识[J]. 中国儿童保健杂志, 2022, 30(3): 233-236.

基金资助

中国疾病预防控制中心妇幼保健中心2019年度“母婴营养与健康研究项目”(2019FYH026)