探讨本研究自行制定的早产儿新生儿重症监护病房(NICU)内早期干预＋出院后早期干预的早期神经发展计划，对其神经系统发育的影响。

本研究采用前瞻性研究方法，选择2017年3月至2018年3月，于广西壮族自治区妇幼保健院NICU住院治疗的204例早产儿(28周≤胎龄<34周)为研究对象。根据早产儿监护人是否同意对早产儿实施早期神经发展计划，将其分为干预组(n＝113，接受NICU内早期干预＋出院后早期干预措施)和对照组(n＝91，仅接受出院后常规随访指导)。对2组早产儿出院后均定期随访，直至其校正胎龄12个月龄时。采用独立样本t检验及秩和检验，对2组患儿一般临床资料、并发症发生情况及住院情况进行比较；采用χ²检验，对2组患儿不同校正胎龄的神经发育评估指标异常率，进行统计学比较。本研究获得本院伦理委员会批准(审查日期：2017年2月27日)，所有受试儿监护人签署临床研究知情同意书。

①2组早产儿呼吸窘迫综合征(NRDS)、支气管肺发育不良(BPD)、喂养不耐受、败血症、高胆红素血症、轻度窒息及Ⅲ度颅内出血发生率，以及呼吸机使用时间比较，差异均无统计学意义(均为P>0.05)。干预组患儿静脉营养时间及住院时间，均短于对照组，并且差异均有统计学意义(P<0.05)。②干预组患儿校正胎龄40周时的振幅整合脑电图(aEEG)、新生儿20项行为神经测查(NBNA)评分及脑干听觉诱发电位(BAEP)异常率，以及校正胎龄1、3个月龄时的全身运动(GMs)评估异常率，分别为15.0%、15.0%、13.3%、12.4%、9.7%，均显著低于对照组的26.4%、26.4%、24.2%、23.1%、22.0%，并且差异均有统计学意义(χ²＝4.029、P＝0.045，χ²＝4.029、P＝0.045，χ²＝4.035、P＝0.045，χ²＝4.051、P＝0.044，χ²＝5.863、P＝0.015)。③2组患儿校正胎龄34、37周时的aEEG异常率，以及校正胎龄40周时的头颅MRI异常率比较，差异均无统计学意义(P>0.05)。④干预组患儿校正胎龄6、12个月龄时的《Gesell发育量表》大运动行为、精细动作行为、语言行为、适应行为及个人社交行为5项能区发育异常率，分别为7.1%、6.2%，8.8%、7.1%，6.2%、6.2%，8.0%、6.2%，9.7%、7.1%，均显著低于对照组的17.6%、16.5%，19.8%、17.6%，18.7%、17.6%，17.6%、15.4%，20.9%、18.7%，并且差异均有统计学意义(均为P<0.05)。

采取本研究自行制定的早期神经发展计划，对早产儿是安全、有效的，较仅接受出院后常规随访指导的早产儿，可更好促进其中脑损伤高危早产儿的神经系统发育。

To explore effects of early neurodevelopment plan for premature infants designed by ourselves in this study which included early intervention in neonatal intensive care unit(NICU) and early intervention right after discharge on nervous system development in premature infants.

By prospective study method, a total of 204 premature infants (28 weeks ≤ gestational age< 34 weeks) who were hospitalized in NICU of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from March 2017 to March 2018, were selected as research subjects.According to whether their guardians agree to take early neurodevelopment plan or not to premature infants, they were divided into intervention group (n=113, implemented early intervention in NICU and early intervention right after discharge) and control group (n=91, only took regular follow-up guidance after discharge). Premature infants in two groups were regularly followed up after discharge until their corrected gestational age of 12 months.Their general clinical data, complications and hospitalization conditions between two groups were compared by independent sample t-test or rank sum test.The abnormal rate of neurodevelopmental assessment indexes in different corrected gestational age of premature infants between two groups were compared by chi-square test.The study was approved by the Ethics Committee of our hospital (review date: February 27, 2017). All premature infants′ guardians signed informed consents for clinical studies.

①There were no significant differences in incidence of neonatal respiratory distress syndrome (NRDS), bronchopulmonary dysplasia (BPD), feeding intolerance, sepsis, hyperbilirubinemia, mild asphyxia and Ⅲ degree of intracranial hemorrhages, as well as ventilator using time of premature infants between two groups (P>0.05 in all of them). The duration of intravenous nutrition and hospitalization of premature infants in intervention group were shorter than those in control group, and the differences were statistically significant (P<0.05). ②The abnormal rates of amplitude integrated electroencephalogram (aEEG), neonatal behavioral neurological assessment (NBNA) scores and brainstem auditory evoked potential (BAEP) at corrected gestational age of 40 weeks, and abnormal rates of evaluation of general movements (GMs) at corrected gestational age of 1 and 3 months of premature infants in intervention group were 15.0%, 15.0%, 13.3%, 12.4% and 9.7%, respectively, which were significantly lower than those of 26.4%, 26.4%, 24.2%, 23.1% and 22.0%, respectively in control group, and the differences were statistically significant (χ²=4.029, P=0.045; χ²=4.029, P=0.045; χ²=4.035, P=0.045; χ²=4.051, P=0.044; χ²=5.863, P=0.015). ③There were no significant differences in abnormal rates of aEEG at corrected gestational age of 34 and 37 weeks of premature infants, and abnormal rates of head MRI at corrected gestational age of 40 weeks of premature infants between two groups (P>0.05). ④The abnormal rates of 5 Gesell subscales of Gesell Development Scale including gross motor behavior, fine motor behavior, language behavior, adaptive behavior and personal social behavior at corrected gestational age of 6 and 12 months of premature infants in intervention group were 7.1% and 6.2%, 8.8% and 7.1%, 6.2% and 6.2%, 8.0% and 6.2%, 9.7% and 7.1%, respectively, which were significantly lower than those of 17.6% and 16.5%, 19.8% and 17.6%, 18.7% and 17.6%, 17.6% and 15.4%, 20.9% and 18.7%, respectively in control group, and the differences were statistically significant (all P<0.05).

Early neurodevelopment plan for premature infants designed by ourselves in this study which is safe and effective on nervous system development in premature infants with high risk of brain injury, which can better promote development of their nervous system than those who only take regular follow-up guidance after discharge.