神经发育早期干预在早产儿纵向发育中的应用效果
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摘要
目的分析神经发育早期干预在早产儿神经发育中的作用,为改善早产儿神经发育预后提供依据。方法 2014年10月-2015年10月以承德医学院附属医院出生60早产儿为研究对象,按照家属意愿分为干预组和对照组;抽取同期出生的30例足月儿作为足月儿组。收集一般资料及家庭资料,并在生后3个月、1岁、2岁、3岁时用Gesell发展量表行神经发育评估,并进行纵向对比。结果干预组早产儿在生后1岁时各项神经行为发育均优于对照组(P<0.05),大运动发育与足月儿差异无统计学意义(P>0.05);3岁时干预组神经发育与足月儿差异无统计学意义(P>0.05);而对照组语言、精细运动仍明显落后于干预组及足月儿组(P<0.05)。纵向比较发现,干预组早产儿神经发育追赶发生较早且追赶速度较快。结论早期进行神经发育干预能尽早改善早产儿神经发育,实现神经发育追赶生长。
Objective To analyze the role of early intervention of nerve development on longitudinal development of premature infants, in order to provide evidence for improving prognosis. Methods Totally 60 premature infants born in Affiliated Hospital of Chengde Medical University were divided into intervention group and control group according to the willing of the family, and 30 full-term infants were selected as the term group from October 2014 to October 2015.The clinical data of preterm infants and their mothers were retrospectively collected.And the neurodevelopmental evaluation was performed with Gessel Development Scale at the age of 3 months old, 1 year old, 2 years old and 3 years old and the results were compared longitudinally. Results The neurobehavioral development of preterm infants in intervention group was superior to that in control group at the age of 1 year old(P<0.05), but there was no significant difference on gross motor movement development between intervention group and the term infants(P>0.05).There was no difference between the intervention group and the term infants on neurobehavioral development at 3 years old(P>0.05).But the language and the fine movement in control group still lagged behind the intervention group and term group(P<0.05).The longitudinal comparison indicated that the preterm infants in the intervention group had earlier neurodevelopmental catch-up and faster catch-up speed. Conclusion Early intervention of nerve development can improve the nerve development of premature infants as early as possible and realize the catch-up growth of nerve development.
Objective To analyze the role of early intervention of nerve development on longitudinal development of premature infants, in order to provide evidence for improving prognosis. Methods Totally 60 premature infants born in Affiliated Hospital of Chengde Medical University were divided into intervention group and control group according to the willing of the family, and 30 full-term infants were selected as the term group from October 2014 to October 2015.The clinical data of preterm infants and their mothers were retrospectively collected.And the neurodevelopmental evaluation was performed with Gessel Development Scale at the age of 3 months old, 1 year old, 2 years old and 3 years old and the results were compared longitudinally. Results The neurobehavioral development of preterm infants in intervention group was superior to that in control group at the age of 1 year old(P<0.05), but there was no significant difference on gross motor movement development between intervention group and the term infants(P>0.05).There was no difference between the intervention group and the term infants on neurobehavioral development at 3 years old(P>0.05).But the language and the fine movement in control group still lagged behind the intervention group and term group(P<0.05).The longitudinal comparison indicated that the preterm infants in the intervention group had earlier neurodevelopmental catch-up and faster catch-up speed. Conclusion Early intervention of nerve development can improve the nerve development of premature infants as early as possible and realize the catch-up growth of nerve development.
引文
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[14] 刘维民,鲍秀兰,马磊,等.早期干预降低极低出生体重儿脑瘫发生率的临床研究[J].中国儿童保健杂志,2015,23(4):360-363.
[15] Barre N, Morgan A, Doyle LW, et al.Language abilities in children who were very preterm and/or very low birth weight:a meta-analysis[J].J Pediatr,2011,158(5):766-774.
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[17] Saigal S, Day KL,van Lieshout RJ, et al.Health, wealth, social integration, and sexuality of extremely low-birth-weight prematurely born adults in the fourth decade of life[J].JAMA Pediatr,2016,170(7):678-686.
[18] Johnson S,Wolke D.Behavioural outcomes and psychopathology during adolescence[J].Early Hum Dev,2013,89(4):199-207.
[2] Glass HC,Costarino AT, Stayer SA, et al.Outcomes for extremely premature infants[J].Anesth Analg,2015,120(6):1337-1351.
[3] Patel RM, Kandefer S, Walsh MC,et al.Causes and timing of death in extremelypremature infants from 2000 through 2011[J].N Engl J Med,2015,372(4):331-340
[4] 吴彤,王来栓.早产儿远期发育结局及成年代谢性疾病的研究进展[J].中华围产医学杂志,2018,21(6):413-416
[5] 张梅,钱红艳,匡晓妮,等.早产儿矫正年龄1岁时神经发育特征分析[J].中国当代儿科杂志,2017,19(2):147-151.
[6] 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,2015,24(11):CD005495.
[7] 陈超,魏克伦,姚裕家,等.早产儿管理指南[J].中华儿科杂志,2006,44(3):188-191.
[8] 鲍秀兰.0～3岁儿童最佳的人生开端(高危儿卷)[M].北京:中国妇女出版社,2013:64-68.
[9] 吴满红,常燕群,李奎,等.早期干预对早产儿运动和智力发育的影响[J].中国康复理论与实践,2013,19(3):261-262.
[10] 黎江,薄涛,陈铁强,等.181例早产儿神经行为发育的回顾性研究[J].中国当代儿科杂志,2014,16(7):696-700.
[11] 黄海燕,陆岸锋,黄国盛,等.早产儿生后24个月龄的神经心理发育研究[J].中国儿童保健杂志,2018,26(4):424-426.
[12] Mwaniki MK, Atieno M, Lawn JE, et al.Long-term neurodevelopmental outcomes after intrauterine and neonatal insults:a systematic review[J].Lancet,2012,379(9814):445-452.
[13] Lawrence EJ,Froudist-Walsh S, Neilan R, et al.Motor fMRI and cortical grey matter volume in adults bornvery preterm[J].Dev Cogn Neuro Sci,2014,10:1-9.
[14] 刘维民,鲍秀兰,马磊,等.早期干预降低极低出生体重儿脑瘫发生率的临床研究[J].中国儿童保健杂志,2015,23(4):360-363.
[15] Barre N, Morgan A, Doyle LW, et al.Language abilities in children who were very preterm and/or very low birth weight:a meta-analysis[J].J Pediatr,2011,158(5):766-774.
[16] Luu TM, Vohr BR, Allan W, et al.Evidence for catch-up in cognition and receptive vocabulary among adolescents born very preterm[J].Pediatrics,2011,128(2):313-322.
[17] Saigal S, Day KL,van Lieshout RJ, et al.Health, wealth, social integration, and sexuality of extremely low-birth-weight prematurely born adults in the fourth decade of life[J].JAMA Pediatr,2016,170(7):678-686.
[18] Johnson S,Wolke D.Behavioural outcomes and psychopathology during adolescence[J].Early Hum Dev,2013,89(4):199-207.
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