家庭养育环境对高危儿18月龄神经精神发育的影响分析

Analysis of the impact of family nurturing environment on neuropsychological development at 18 months in high-risk children

摘要

目的 分析家庭养育环境对新生儿重症监护室(NICU)出院的高危儿18月龄时神经精神发育的影响,为改善家庭养育环境、促进高危儿的早期发展提供依据。方法 选取2019年1月至2022年1月期间出生并在本院高危儿随访门诊进行系统管理的高危儿,采用家庭养育环境问卷和Gesell量表,评估高危儿家庭养育环境和高危儿18月龄发育商,并分析与发育迟缓的关系。结果 共纳入243名高危儿,18月龄时语言能发育迟缓率最高(46.91%),其次为应物能(39.51%).研究对象家庭养育环境“良好”占56.8%,“中等”占41.6%,“不良”占1.6%.家庭养育环境为“良好”的高危儿,全面发育迟缓率降低13.2%(χ²=4.193,P=0.041).与家庭养育环境“良好”的高危儿相比,家庭养育环境为“中等/不良”的高危儿,18月龄出现全面发育迟缓的风险增加至2.04倍(OR=2.04,95%CI:1.13~3.69,P=0.018),粗大运动发育迟缓风险增加至4.95倍(OR=4.95,95%CI:1.65~14.89,P=0.004),精细运动发育迟缓风险增加至2.63倍(OR=2.63,95%CI:1.30~5.31,P=0.007),言语能发育迟缓风险增加至2.19倍(OR=2.19,95%CI:1.23~3.89,P=0.008)。结论 NICU出院的高危儿在语言能、应物能等方面的发育迟缓发生率高于正常婴幼儿.非良好的家庭养育环境是高危儿出现神经精神发育迟缓的危险因素.高危儿早期干预应重视家庭养育环境这一可干预因素,通过定期评估和持续改善,促进高危儿获得良好的神经发育结局.

Abstract

Objective To analyze the impact of family nurturing environment on the neuropsychological development of high-risk children at 18 months of age following discharge from the neonatal intensive care unit (NICU). The aim is to provide evidence for improving the family nurturing environment and promoting the early development of high-risk children. Methods High-risk children born between January 2019 and January 2022 and systematically managed at the high-risk child follow-up clinic of the hospital were selected. The family nurturing environment questionnaire and Gesell developmental schedules were used to assess the family nurturing environment and the developmental quotient (DQ) of high-risk children at 18 months of age. The relationship between the family nurturing environment and developmental delay was analyzed. Results A total of 243 high-risk infants were enrolled. At 18 months, the highest rate of developmental delay was observed in language abilities (46.91%), followed by object response abilities (39.51%). Among the participants, 56.8% had a “good” family nurturing environment, 41.6% had a “moderate” environment, and 1.6% had a “poor” environment. High-risk children from families with a “good” nurturing environment had a 13.2% lower rate of overall developmental delay (χ²=4.193, P=0.041). Compared to children from families with a “good” nurturing environment, those from families with a “moderate” or “poor” environment had: 2.04-fold increased risk of overall developmental delay (OR=2.04, 95%CI: 1.13-3.69, P=0.018), 4.95-fold increased risk of gross motor developmental delay (OR=4.95, 95%CI: 1.65-14.89, P=0.004), 2.63-fold increased risk of fine motor developmental delay (OR=2.63, 95%CI: 1.30-5.31, P=0.007), 2.19-fold increased risk of language developmental delay (OR=2.19, 95%CI: 1.23-3.89, P=0.008). Conclusion High-risk infants discharged from the NICU exhibit higher rates of developmental delay in language and object response abilities compared to typically developing infants. A suboptimal family nurturing environment is a risk factor for neuropsychological developmental delays in high-risk children. Early interventions for high-risk children should prioritize improving the family nurturing environment, which is a modifiable factor. Regular evaluations and continuous improvements in the family nurturing environment can help promote favorable neurodevelopmental outcomes in high-risk children.

关键词

高危儿 / 婴幼儿 / 家庭养育环境 / 神经精神发育 / 早期发展

Key words

high-risk child / infant and toddler / family nurturing environment / neuropsychological development / early development

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基金资助

上海市卫生健康委员会2021年上海市卫健委卫生行业临床研究专项项目(202140299)