支气管肺发育不良早产儿生后1年内神经行为发育的临床分析

A clinical analysis of neurobehavioral development within one year after birth in preterm infants with bronchopulmonary dysplasia

摘要:

目的 探讨支气管肺发育不良（BPD）对早产儿生后1年内神经行为发育的影响。方法 回顾性选取2017年9月至2019年12月间出生胎龄 < 34周，并完成纠正胎龄40周及3、6、12月龄神经行为发育随访的早产儿为研究对象。根据诊断分为BPD组（n=23）和非BPD组（n=27），比较两组患儿不同时点的神经行为发育结果。结果 BPD组与非BPD组患儿纠正胎龄40周时新生儿神经行为测定评分差异无统计学意义（P > 0.05）。Gesell发育量表中，BPD组纠正胎龄3、6、12月龄时精细动作、适应性行为、社交行为能区发育商（DQ）及总DQ低于非BPD组（P < 0.05）；两组患儿纠正胎龄6月龄时言语能区DQ高于纠正胎龄12月龄（P < 0.017），纠正胎龄6月龄时社交行为能区DQ高于纠正胎龄3月龄（P < 0.017），纠正胎龄12月龄时适应性行为能区DQ高于纠正胎龄3、6月龄（P < 0.017）。Bayley发育量表Ⅱ中，两组患儿各时点智力和运动发展指数差异无统计学意义（P > 0.05），纠正胎龄3月龄时智力发展指数高于纠正胎龄6、12月龄（P < 0.001）。结论 BPD早产儿在生后1年内较非BPD早产儿存在神经发育落后，临床需给予重视。

Abstract:

Objective To study the effect of bronchopulmonary dysplasia (BPD) on neurobehavioral development within one year after birth in preterm infants. Methods A retrospective analysis was performed for the preterm infants with a gestational age of < 34 weeks who were born from September 2017 to December 2019 and completed the follow-up assessments of neurobehavioral development at the corrected gestational ages of 40 weeks and 3, 6, and 12 months. According to their diagnosis, they were divided into a BPD group with 23 infants and a non-BPD group with 27 infants. The outcome of neurobehavioral development was compared between the two groups at different time points. Results There was no significant difference in the neonatal behavioral neurological assessment score between the BPD and non-BPD groups at the corrected gestational age of 40 weeks (P > 0.05). Based on the Gesell Developmental Scale, compared with the non-BPD group, the BPD group had significantly lower global developmental quotient (DQ) and DQs of fine motor, adaptive behavior, and personal-social behavior at the corrected gestational ages of 3, 6, and 12 months (P < 0.05). For both groups, the DQ of language at the corrected gestational age of 6 months was significantly higher than that at the corrected gestational age of 12 months (P < 0.017), the DQ of personal-social behavior at the corrected gestational age of 6 months was significantly higher than that at the corrected gestational age of 3 months (P < 0.017), and the DQ of adaptive behavior at the corrected gestational age of 12 months was significantly higher than that at the corrected gestational ages of 3 and 6 months (P < 0.017). Based on the BSID-II scale, there were no significant differences in mental development index and psychomotor development index at each time point between the two groups (P > 0.05). The mental development index at the corrected gestational age of 3 months was significantly higher than that at the corrected gestational ages of 6 and 12 months in both groups (P < 0.001). Conclusions Preterm infants with BPD have delayed neurodevelopment within one year after birth compared with those without BPD, which should be taken seriously in clinical practice.