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目的探讨高危因素对早产儿营养、智能、神经发育的影响及干预效果。方法选择2008年1~12月在我院出生并定期在儿童保健科进行体格检查的早产儿,根据是否伴有高危因素(超早产、极低出生体重、脑损伤、高胆红素血症、重度窒息)分为高危因素组和非高危因素组。高危因素组再根据家长干预依从性分成干预组和非干预组,同时匹配本院足月分娩的健康婴幼儿为足月儿组。比较不同组别校正年龄2岁时的营养、智能和神经发育结局以及干预效果。结果完成随访早产儿372例,其中非高危因素组223例,高危因素组149例(干预组71例,非干预组78例),足月儿组231例。不同组别婴幼儿性别、分娩方式、家庭经济水平,以及干预组与非干预组基础疾病差异均无统计学意义(P>0.05)。校正年龄2岁时,高危因素组贫血和维生素D缺乏发生率高于非高危因素组(15.4%比6.7%,19.5%比11.2%),非干预组高于干预组(23.1%比7.0%,25.6%比12.7%),早产儿组、高危因素组和非干预组发育商(DQ,分)均低于相应的足月儿组、非高危因素组和干预组[(85.2±11.4)比(98.3±5.3),(79.5±13.4)比(89.0±7.8),(71.2±10.9)比(88.6±9.4)],智能低下和脑性瘫痪发生率均高于相对应的足月儿组、非高危因素组和干预组(智能低下:7.0%比0.4%,16.8%比0.5%,30.8%比1.4%,脑性瘫痪:3.0%比0.4%,6.0%比0.9%,10.3%比1.4%),差异均有统计学意义(P<0.05)。结论 2岁内早产儿发育落后于足月儿,高危因素增加早产儿营养不良、DQ低下和脑性瘫痪的风险,而干预能一定程度改善早产儿发育。
Objective To investigate the effect of risk factors on nutrition, intelligence and neurodevelopment of premature infants and the intervention effect. Methods Preterm infants born in our hospital from January to December in 2008 and who undergo physical examinations regularly in children’s health department were selected according to whether they were associated with high risk factors (premature birth, very low birth weight, brain injury, hyperbilirubinemia, Severe asphyxia) were divided into high risk group and non-risk group. The risk factors group was divided into intervention group and non-intervention group according to the parental intervention compliance, and the full-term healthy infants matched with full-term delivery in our hospital were full-term infants. The nutritional, intellectual and neurodevelopmental outcomes at 2 years of age in different groups were compared and the effects of intervention were compared. Results A total of 372 preterm infants were followed up, of which 223 were non-risk factors, 149 were risk factors (intervention group, 71 patients, non-intervention group, and n = 231). There was no significant difference in gender, mode of delivery, family economic status, and basic diseases between intervention group and non-intervention group in different groups (P> 0.05). At 2 years of age at correction, the incidence of anemia and vitamin D deficiency in the high-risk group was higher than in the non-risk group (15.4% vs. 6.7%, 19.5% vs 11.2%), in the non-intervention group (23.1% vs. 7.0% 25.6% vs 12.7%), premature infant group, high risk group and non-intervention group (DQ) were lower than corresponding full-term infants, non-risk group and intervention group [(85.2 ± 11.4) vs 98.3 ± 5.3), (79.5 ± 13.4) vs (89.0 ± 7.8), (71.2 ± 10.9) vs (88.6 ± 9.4), respectively. The incidences of mental retardation and cerebral palsy were both higher than those of corresponding full-term infants, The risk factors and intervention groups (low intelligence: 7.0% vs 0.4%, 16.8% vs 0.5%, 30.8% vs 1.4%, cerebral palsy: 3.0% vs 0.4%, 6.0% vs 0.9%, 10.3% vs 1.4% , The differences were statistically significant (P <0.05). Conclusion The development of premature infants in 2 years old lags behind that in term infants. The risk factors of malnutrition, DQ and cerebral palsy in preterm infants are increased. However, intervention can improve the development of premature infants to a certain extent.