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目的探讨极低出生体重儿(very low birth weight infant,VLBWI)和超低出生体重儿(extremely birth weight infant,ELBWI)不同时期神经发育损害发生的变化趋势。方法复旦大学附属儿科医院新生儿科2005年10月1日-2010年12月31日收治并救治成活的VLBWI和ELBWI,纠正胎龄18~42个月,完成贝莉婴儿发育量表-Ⅱ(Bayley Scales of Infant Development-Ⅱ,BSID-Ⅱ)的患儿有143例,按入院时间分为两个阶段,第一阶段为2005年10月1日-2008年12月31日入院的患儿,共54例;第二阶段为2009年1月1日-2010年12月31日入院的患儿,共89例。比较两个阶段患儿的神经发育预后情况。结果两个阶段的研究对象在性别、胎龄、出生体重及分布上均相似。第一阶段患儿的智力发育指数得分(88.6±19.2)显著低于第二阶段(97.0±14.6)(P=0.004);第一阶段患儿智力发育指数<70的发生率(14.8%)显著高于第二阶段(3.4%)(P=0.014)。第一阶段患儿总体神经发育损害的发生率(22.2%)高于第二阶段(13.5%),脑瘫发生率(9.3%)高于第二阶段(2.3%),心理运动发育指数得分(83.6±16.1)低于第二阶段(85.0±13.6),心理运动发育指数<70分的发生率(16.7%)高于第二阶段(12.4%),但这几个方面的差异均无统计学意义。结论医生和家长均应重视VLBWI和ELBWI的出院后随访及早期干预,以改善患儿的神经发育预后。
Objective To investigate the changes of neurodevelopmental damage in very low birth weight infant (VLBWI) and extremely birth weight infant (ELBWI) in different periods. Methods Neonatology department of Pediatric Hospital Affiliated to Fudan University received treatment of surviving VLBWI and ELBWI from October 1, 2005 to December 31, 2010 to correct gestational age from 18 to 42 months and complete the Bayley Scale for Infant Development-Ⅱ Scales of Infant Development-Ⅱ, BSID-Ⅱ) of 143 cases of children, according to admission time is divided into two stages, the first stage for the October 1, 2005 -2008 on December 31 admitted to the hospital, a total of 54 cases; the second phase for the January 1, 2009 - December 31, 2010 hospitalized children, a total of 89 cases. The prognosis of children with neurological deficits in two stages was compared. Results The subjects of the two phases were similar in gender, gestational age, birth weight and distribution. The score of mental development index (88.6 ± 19.2) in the first stage was significantly lower than that in the second stage (97.0 ± 14.6) (P = 0.004). The incidence of mental development index <70 in the first stage was significantly higher than that in the first stage (14.8%) Higher than Stage II (3.4%) (P = 0.014). The incidence of overall neurodevelopmental impairment in the first stage was higher (22.2%) than that in the second stage (13.5%), the incidence of cerebral palsy (9.3%) was higher than that of the second stage (2.3%), and psychomotor development index score ± 16.1) was lower than the second stage (85.0 ± 13.6), the incidence of psychomotor development index <70 was higher than that of the second stage (12.4%), but there was no significant difference in these aspects . Conclusion Both doctors and parents should pay attention to the follow-up and early intervention of VLBWI and ELBWI in order to improve the prognosis of children’s neurodevelopment.