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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (06) : 681 -686. doi: 10.3877/cma.j.issn.1673-5250.2017.06.011

所属专题： 文献；

论著

超低出生体重儿神经行为发育影响因素分析
李燕1, 韦秋芬1, 蒙丹华1, 潘新年1,†(), 莫艳1, 姚丽平1, 经连芳1, 赵丹1, 沈开颜1, 许靖1   
  1. 1. 530003　南宁，广西壮族自治区妇幼保健院新生儿科
  • 收稿日期:2017-04-19 修回日期:2017-10-13 出版日期:2017-12-01
  • 通信作者: 潘新年

Influencing factors analysis of neurobehavioral development in extremely low birth weight infants

Yan Li1, Qiufen Wei1, Danhua Meng1, Xinnian Pan1,†(), Yan Mo1, Liping Yao1, Lianfang Jing1, Dan Zhao1, Kaiyan Shen1, Jing Xu1   

  1. 1. Department of Neonatology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning 530003, Guangxi Zhuang Autonomous Region, China
  • Received:2017-04-19 Revised:2017-10-13 Published:2017-12-01
  • Corresponding author: Xinnian Pan
  • About author:
    Corresponding author: Pan Xinnian, Email:
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引用本文：

李燕, 韦秋芬, 蒙丹华, 潘新年, 莫艳, 姚丽平, 经连芳, 赵丹, 沈开颜, 许靖. 超低出生体重儿神经行为发育影响因素分析[J/OL]. 中华妇幼临床医学杂志(电子版), 2017, 13(06): 681-686.

Yan Li, Qiufen Wei, Danhua Meng, Xinnian Pan, Yan Mo, Liping Yao, Lianfang Jing, Dan Zhao, Kaiyan Shen, Jing Xu. Influencing factors analysis of neurobehavioral development in extremely low birth weight infants[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(06): 681-686.

目的

探讨超低出生体重儿(ELBWI)的神经行为发育的影响因素，旨在提高ELBWI生存质量。

方法

选择2010年1月1日至2015年5月31日在广西妇幼保健院新生儿科重症监护病房(NICU)住院治疗并治愈出院的88例ELBWI的临床病例资料为研究对象。根据随访结果是否为神经行为发育障碍，将患儿分为神经行为发育障碍组(n＝15)及神经行为发育正常组(n＝73)。对ELBWI的临床病例资料进行回顾性分析，并对ELBWI神经行为发育的影响因素进行统计学分析。①2组ELBWI母亲产前一般临床资料比较，包括母亲年龄>35岁、分娩前未使用激素、接受辅助生殖、妊娠期高血压疾病、妊娠期糖尿病、胎膜早破、宫内感染以及妊娠期肝内胆汁淤积症(ICP)所占比例，共计8项因素。②2组ELBWI一般临床资料比较，包括胎龄构成比、小于胎龄(SGA)儿所占比例、Ⅲ～Ⅳ度脑室内出血(IVH)所占比例等18项因素。③结合临床经验以及对ELBWI神经行为发育影响因素的单因素分析结果中，母亲及新生儿因素中差异具有统计学意义的因素，进行多因素非条件logistic回归分析。本研究遵循的程序符合广西壮族自治区妇幼保健院人体试验委员会制定的伦理学标准，得到该委员会批准。

结果

①单因素分析结果显示，神经行为发育障碍组母亲宫内感染所占比例高于神经行为发育正常组，并且差异有统计学意义(P<0.05)；神经行为发育障碍组ELBWI的胎龄构成比小于神经行为发育正常组，并且SGA儿、Ⅲ～Ⅳ度IVH所占比例均高于神经行为发育正常组，并且差异均有统计学意义(P<0.05)。② ELBWI神经行为发育影响因素的多因素非条件logistic回归分析结果显示，宫内感染(OR＝43.644，95%CI：2.545～748.368，P＝0.009)及Ⅲ～Ⅳ度IVH(OR＝55.837，95%CI：3.422～910.988，P＝0.005)是ELBWI神经行为发育障碍的独立危险因素，胎龄(OR＝0.067，95%CI：0.006～0.821，P＝0.035)是ELBWI神经行为发育障碍的独立保护因素。

结论

ELBWI神经行为发育障碍与早产、宫内感染及合并Ⅲ～Ⅳ度IVH有关，需积极采取措施预防早产、控制宫内感染和减少严重IVH的发生。

关键词: 发育障碍, 危险因素, 预后, 婴儿，超低出生体重
Objective

To investigate influencing factors of neurobehavioral development in extremely low birth weight infants (ELBWI).

Methods

From January 1, 2010 to May 31, 2015, a total of 88 ELBWI in the neonatal intensive care unit (NICU) of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, were included into this study. They were divided into neurobehavioral development disability group (n=15) and neurobehavioral development normal group (n=73) according to the follow-up results with neurobehavioral development or not. The clinical data between two groups were analyzed, and influencing factors of neurobehavioral development in ELBWI were analyzed by statistical analysis. ① A total of 8 items of maternal information between two groups were compared, including proportion of maternal age >35-year-old and non-exposure to prenatal hormones, assisted reproductive technology, gestational hypertension disease, gestational diabetes mellitus, premature rupture of membranes, and intrauterine infection, and intrahepatic cholestasis of pregnancy (ICP). ② A total of 18 items of ELBWI between two groups were compared, including constituent ratio of gestational age, and proportion of small for age (SGA) infants, intraventricular hemorrhage (IVH) grade III-IV, and so on. Based on the existing studies, clinical experience and univariate analysis results, the 4 influencing factors related to neurodevelopmental outcomes of ELBWI were analyzed by multivariate unconditional logistic analysis. The procedures followed in this study were in line with the ethical standards set by Ethical Review Board of Investigation in Human Beings of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region and were approved by the committee.

Results

①The univariate analysis showed the following results. The proportion of intrauterine infection of puerperant in neurobehavioral development disability group was higher than that of neurobehavioral development normal group, the constituent ratio of gestational age of ELBWI in neurobehavioral development disability group was younger than that of neurobehavioral development normal group, furthermore, the proportions of SGA infants and IVH grade Ⅲ-Ⅳ in neurobehavioral development disability group were higher than those in neurobehavioral development normal group, and all the above differences were statistically significant (P<0.05). ② Multivariate unconditional logistic analysis showed the following results. Intrauterine infection (OR=43.644, 95%CI: 2.545-748.368, P=0.009) and IVH grade Ⅲ-Ⅳ (OR=55.837, 95%CI: 3.422-910.988, P=0.005) were independent risk factors about neurobehavioral development in ELBWI. Gestational age (OR=0.067, 95%CI: 0.006-0.821, P=0.035) was the independent protective factor about neurobehavioral development in ELBWI.

Conclusions

It is necessary to take active measures to prevent neurodevelopmental disability by preventing premature delivery, controlling intrauterine infection and reducing the occurrence of severe IVH.

Key words: Developmental disabilities, Risk factors, Prognosis, Infant, extremely low birth weight
表1 2组超低出生体重儿母亲产前临床资料比较[例数(%)]
组别 例数 孕母年龄>35岁 接受辅助生殖 妊娠期高血压疾病 妊娠期糖尿病 胎膜早破 宫内感染 分娩前未使用激素 ICP
神经行为发育障碍组 15 6(40.0) 4(26.7) 8(53.3) 5(33.3) 6(40.0) 6(40.0) 11(73.3) 6(40.0)
神经行为发育正常组 73 18(24.7) 9(12.3) 40(54.8) 14(19.2) 23(31.5) 9(12.3) 43(58.9) 20(27.4)
χ2值 ? 0.804 a 1.052 a 0.011 0.755 a 0.113 a 4.923 a 1.093 0.441 a
P值 ? 0.370 0.305 0.918 0.385 0.737 0.026 0.296 0.507
表2 2组起低出生体重儿一般临床资料比较[例数(%)]
组别 例数 胎龄 生后5 min Apgar评分 SGA儿 经阴道分娩
≤28周 >28～32周 >32～37周 0～4分 ≥4～8分 ≥8～10分
神经行为发育障碍 15 10(66.7) 4(26.7) 1(6.7) 5(33.3) 7(46.7) 3(20.0) 12(80.0) 7(46.7)
神经行为发育正常 73 24(32.9) 34(46.6) 15(20.6) 9(12.3) 30(41.1) 34(46.6) 38(52.1) 50(68.5)
χ2值 ? 6.138 a 5.633 a 3.961 2.598
P值 ? 0.046 0.060 0.047 0.107
组别 例数 NRDS 宫内感染性肺炎 支气管肺发育不良 Ⅲ～Ⅳ度IVH 动脉导管未闭 喂养不耐受 NEC 高胆红素血症
神经行为发育障碍 15 10(66.7) 6(40.0) 8(53.3) 4(26.7) 8(53.3) 7(46.7) 6(40.0) 14(93.3)
神经行为发育正常 73 43(58.9) 15(20.6) 42(57.5) 2(2.7) 24(32.9) 19(26.0) 17(23.3) 60(82.2)
χ2值 ? 0.313 1.631 a 0.090 7.763 a 2.250 1.651 a 1.039 a 0.472 a
P值 ? 0.576 0.202 0.765 0.005 0.134 0.199 0.308 0.492
组别 例数 贫血 败血症 真菌感染 低血糖 甲状腺功能低下 早产儿视网膜病
神经行为发育障碍 15 11(73.3) 11(73.3) 5(33.3) 7(46.7) 2(13.3) 10(66.7)
神经行为发育正常 73 58(79.5) 43(58.9) 10(13.7) 27(37.0) 2(2.7) 30(41.1)
χ2值 ? 0.032 a 1.093 2.146 a 0.168 － b 3.282
P值 ? 0.858 0.296 0.143 0.682 0.133 0.070
表3 超低出生体重儿神经行为发育影响因素的多因素非条件logistic回归分析的变量含义及赋值情况
解释变量/结局变量 变量名 赋值
ELBWI神经行为发育 y y＝0表示未发生神经行为发育障碍，y＝1表示发生神经行为发育障碍
胎龄 x1 x1＝0表示胎龄≤28周，x1＝1表示28周<胎龄≤32周，x1＝2表示32周<胎龄≤37周
SGA儿 x2 x2＝0表示非SGA儿，x2＝1表示SGA儿
宫内感染 x3 x3＝0表示未发生宫内感染，x3＝1表示发生宫内感染
Ⅲ～Ⅳ度IVH x4 x4＝0表示未发生Ⅲ～Ⅳ度IVH，x4＝1表示发生Ⅲ～Ⅳ度IVH
表4 超低出生体重儿神经行为发育影响因素的多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
胎龄 －2.700 1.277 4.469 0.035 0.067 0.006～0.821
宫内感染 3.776 1.450 6.782 0.009 43.644 2.545～748.368
Ⅲ～Ⅳ度IVH 4.022 1.425 7.973 0.005 55.837 3.422～910.988
SGA儿 1.442 1.231 1.373 0.241 4.230 0.379～47.189
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