CAJ | 학술논문

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)神经发育结局及其影响因素. 方法采用回顾性分析方法.2005年10月至2009年11月,复旦大学附属儿科医院新生儿科收治并救治存活的VLBWI和ELBWI、校正胎龄18～42个月时完成贝利婴儿发育量表Ⅱ(Baley Scales of Infant DevelopmentⅡ,BayleyⅡ)测试的患儿共85例,除外在外院治疗时间较长(≥10 d)的12例后,有73例患儿纳入研究.根据美国国立儿童健康与人类发育研究所对神经发育损害的定义,将73例患儿分为神经发育正常组和神经发育损害组,对可能的影响因素进行Logistic逐步回归分析. 结果 73例患儿平均胎龄(30.4±2.3)周,胎龄＜28周13例,～32周42例,＞32周18例.出生体重平均(1208.0±208.5)g,＜1000 g 15例(20.6％),～1500 g 58例(79.4％).运动发育落后4例(5.5％)；发生神经发育损害者16例(21.9％),其中BayleyⅡ测试中单纯心理运动发育指数＜70分者6例(8.2％,其中1例合并脑性瘫痪),单纯智力发育指数＜70分者2例(2.7％),心理运动发育指数及智力发育指数均＜70分者7例(9.6％,其中2例合并脑性瘫痪),单纯脑性瘫痪1例(1.4％).无一例发生单眼或双眼失明或需要助听器的听力损害.Logistic逐步回归分析提示,使用机械通气与VLBWI和ELBWI发生神经发育损害相关(OR=6.183,95％CI:1.664～22.983,P=0.003).使用机械通气的患儿(n=27)心理运动发育指数为(77.5±15.1)分,明显低于未使用机械通气的患儿[n=46,(87.3±15.1)分],差异有统计学意义(t=2.646,P=0.010). 结论 VLBWI和ELBWI发生神经发育损害的比例较高,尤其是使用机械通气的患儿.
목적 탐토겁저출생체중인(very low birth weight infant,VLBWI)화초저출생체중인(extremely birth weight infant,ELBWI)신경발육결국급기영향인소. 방법 채용회고성분석방법.2005년10월지2009년11월,복단대학부속인과의원신생인과수치병구치존활적VLBWI화ELBWI、교정태령18～42개월시완성패리영인발육량표Ⅱ(Baley Scales of Infant DevelopmentⅡ,BayleyⅡ)측시적환인공85례,제외재외원치료시간교장(≥10 d)적12례후,유73례환인납입연구.근거미국국립인동건강여인류발육연구소대신경발육손해적정의,장73례환인분위신경발육정상조화신경발육손해조,대가능적영향인소진행Logistic축보회귀분석. 결과 73례환인평균태령(30.4±2.3)주,태령＜28주13례,～32주42례,＞32주18례.출생체중평균(1208.0±208.5)g,＜1000 g 15례(20.6％),～1500 g 58례(79.4％).운동발육락후4례(5.5％)；발생신경발육손해자16례(21.9％),기중BayleyⅡ측시중단순심리운동발육지수＜70분자6례(8.2％,기중1례합병뇌성탄탄),단순지력발육지수＜70분자2례(2.7％),심리운동발육지수급지력발육지수균＜70분자7례(9.6％,기중2례합병뇌성탄탄),단순뇌성탄탄1례(1.4％).무일례발생단안혹쌍안실명혹수요조은기적은력손해.Logistic축보회귀분석제시,사용궤계통기여VLBWI화ELBWI발생신경발육손해상관(OR=6.183,95％CI:1.664～22.983,P=0.003).사용궤계통기적환인(n=27)심리운동발육지수위(77.5±15.1)분,명현저우미사용궤계통기적환인[n=46,(87.3±15.1)분],차이유통계학의의(t=2.646,P=0.010). 결론 VLBWI화ELBWI발생신경발육손해적비례교고,우기시사용궤계통기적환인.
Objective To investigate the neurodevelopmental outcomes and its risk factors of very low birth weight infant (VLBWI) and extremely low birth weight infants (ELBWI).Methods Data of 85 VLBWI and ELBWI hospitalized in Children's Hospital of Fudan University from October 2005 to November 2009 who had finished infant development test of Baley Scales of Infant Development Ⅱ (Bayley Ⅱ) for neurological development at corrected gestational age between 18 to 42 months were retrospectively reviewed.Twelve infants who accepted treatment in other hospital over 10 days were excluded; the rest 73 infants were divided into normal (neurodevelopment) group or abnormal group according to the definition of neurodevelopmental impairment reported by National Institute of Child Health and Human Development (NICHD) Neonatal Network.Potential risk factors of neurodevelopmental impairment were analyzed with Logistic stepwise regression.Results The mean gestational age of 73 infants was (30.4±2.3) weeks; among which 13 were smaller than 28 weeks,42 between 28 and 32 weeks,and 18 older than 32 weeks.The mean birth weight was (1208.0±208.5) g; among which 15 (20.6％) ＜1000 g,and 58 (79.4％) were between 1000 g and 1500 g.Four babies (5.5％) were diagnosed as movement retardation,and neurodevelopmental impairment occurred in 16 cases (21.9 ％),psychomotor developmental index ＜70 occurred in 6 cases (8.2％,one case complicating with cerebral palsy); mental developmental index ＜70 occurred in 2 cases (2.7％); both psychomotor developmental index and mental developmental index ＜70 occurred in 7 cases (9.6 ％,two cases complicating with cerebral palsy),and one case (1.4 ％) was cerebral palsy only.Blind in either eyes and hearing impairment requiring deaf-aid were not found in any of the 73 babies.Logistic stepwise regression showed that use of mechanical ventilation was related to neurodevelopmental impairment (OR =6.183,95％ CI:1.664-22.983,P =0.003).Psychomotor developmental index of infants who needed mechanical ventilation (77.5±15.1) was lower than that of infants did not need (87.3±15.1)(t=2.646,P=0.010).Conclusions VLBWI and ELBWI are in high risk of neurodevelopmental impairment,especially those who need mechanical ventilation.