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目的动态监测极低出生体重早产儿的体格发育指标,探寻其宫内生长、生后早期及院外生长速率与婴儿期神经发育的相关性。方法回顾性分析2005年1月至2013年8月期间生后24 h入住我院新生儿监护病房并存活出院的极低出生体重(出生体重<1 500 g)早产儿。体格发育指标以头围和体重的标准差分数(SDS)表示,智力运动发育情况以Gesell发育诊断量表评价。使用LMS growth软件进行SDS计算,SPSS 16.0软件进行描述性分析及Logistic回归分析。结果符合纳入标准患儿共221例,排除参与其他随访项目的患儿52例,纳入分析169例,规律随访患儿138例,随访率81.7%,随访中位校正年龄34.3周,出生、出院及末次随访时生长迟缓(体重SDS≤-2)发生率分别为21.0%、35.0%和7.2%;头围SDS≤-2发生率分别为14.5%、14.5%和19.6%。中位校正周数37.9周的Gesell发育筛查提示适应性、大运动、精细运动、语言及个人社交发育商(DQ)轻中度落后的比例分别为3.8%、19.1%、4.8%、4.8%和2.9%。以二项式Logistic回归分析智力运动发育预后的相关因素,提示生长指标中,头围增长(随访头围SDS-出生头围SDS)与大运动显著相关(P=0.028)。结论极低出生体重儿大运动发育落后最为常见。绝大部分极低出生体重儿的体重在院外实现了追赶性生长,但头围发育落后比例呈上升趋势。头围增长与大运动发育显著相关,提示生后早期营养情况对远期神经发育有一定影响。
Objective To dynamically monitor the physical development of very low birth weight preterm infants and explore their correlation with intrauterine growth, early growth and out-of-hospital growth rate and neurological development during infancy. Methods The data of very low birth weight (birth weight <1 500 g) premature infants admitted to our hospital neonatal intensive care unit and discharged from hospital from January 2005 to August 2013 were retrospectively analyzed. Physical development was expressed as the standard deviation of head circumference and body weight (SDS), and intellectual motor development was evaluated using the Gesell Developmental Diagnostic Scale. Using LMS growth software for SDS calculation, SPSS 16.0 software for descriptive analysis and Logistic regression analysis. Results A total of 221 children were enrolled in this study. Of the 52 children excluded from the other follow-up programs, 169 were included in the analysis, and 138 were followed up regularly. The follow-up rate was 81.7%. The median follow-up was 34.3 weeks. The incidence of delayed growth (SDS≤-2) at the last follow-up was 21.0%, 35.0% and 7.2%, respectively. The incidence of head circumference SDS≤-2 was 14.5%, 14.5% and 19.6% respectively. The Gesell Developmental Screening at 37.9 Weeks with Median Correction Weeks showed a mild to moderate downturn in fitness, motor, fine motor, language and individual social development (DQ) rates of 3.8%, 19.1%, 4.8%, 4.8% And 2.9%. Binomial Logistic regression analysis of mental motor development prognostic factors, suggesting that growth indicators, head circumference growth (follow-up head circumference SDS-head circumference SDS) was significantly associated with large exercise (P = 0.028). Conclusions The development of very low birth weight babies is the most common. The vast majority of very low birth weight children achieved a catch-up growth outside the hospital, but the ratio of head circumference development and backwardness was on the rise. Head circumference growth and development of large sports was significantly correlated, suggesting that early postnatal nutritional status of long-term neurological development have a certain impact.