不同程度早产儿脑室周围-脑室内出血对婴儿期发育的影响

摘要

目的 探讨不同程度早产儿脑室周围-脑室内出血(PIVH)对婴儿期体格发育及神经发育的影响.方法 收集2013年12月至2015年6月在青岛市妇女儿童医院NICU住院诊断为PIVH的早产儿80例,根据Papile分级法将其分为4组,分别为Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级出血组,其中Ⅰ级、Ⅱ级出血组为轻度出血组,Ⅲ级、Ⅳ级出血组为重度出血组,随访12个月.在校正年龄1、2、3、6和12月龄时进行体格发育评估,在校正年龄6月龄及12月龄时应用0～1岁神经运动20项检查和贝利婴儿发展量表进行神经行为发育评估,比较4组早产儿婴儿期体格和神经行为发育的差异.结果 在不同校正年龄,各组早产儿在体质量、身长及体质量增长迟缓的发生率上差异均无统计学意义(P均＞0.05);在校正年龄12月龄时PIVHⅢ、Ⅳ级患儿神经行为异常的发生率高于PIVHⅠ、Ⅱ级患儿,差异有统计学意义(21.05％比3.28％,x2=4.284,P=0.038);在校正年龄6月龄时PIVHⅠ、Ⅱ级患儿运动发育指数(PDI)得分高于PIVHⅢ、Ⅳ级患儿,差异均有统计学意义(F=11.500,P＜0.05);在校正年龄12月龄时PIVHⅠ、Ⅱ级患儿智力发育指数(MDI)、PDI得分均高于PIVHⅢ、Ⅳ级患儿,差异均有统计学意义(F=14.227、16.515,P均＜0.05);在婴儿期PIVHⅢ、Ⅳ级患儿脑性瘫痪和精神运动发育迟滞的发生率明显高于PIVHⅠ、Ⅱ级患儿(21.05％比1.64％,26.32％比4.92％),差异均有统计学意义(x2=6.300、5.185,P=0.012、0.023).结论 婴儿期重度颅内出血对早产儿智力发育存在负面影响,易发生智力低下、脑性瘫痪等神经系统不良后遗症,需定期随访,尽早实施早期干预,促进其发育.%Objective To explore how the severity of periventricular-intraventricular hemorrhage (PIVH)impact on physique and neurodevelopment in premature infants.Methods A total of 80 preterm infants with PIVH admitted to NICU of Qingdao Women and Children's Hospital from December 2013 to June 2015 were eligible.According to the Papile classification,the premature infants were divided into 4 groups.They were grade Ⅰ PIVH group,grade Ⅱ PIVH group,grade Ⅲ PIVH group and grade Ⅳ PIVH group.The infants with grade Ⅰ PIVH and grade Ⅱ PIVH belong to the low-grade PIVH group.The infants with grade Ⅲ PIVH and grade Ⅳ belong to the severe-grade PIVH group.All of them were regularly followed up for 12 months.Neurodevelopmental outcomes of infants at 6 and 12-month correction age were assessed by using the 20 items neuromotor assessment applying for 0-1 year old and the Bayley scales of infant development-Ⅱ.The differences in physical and neurophysical development of premature infants among 4 groups were compared.Results There were no significant differences in physical growth indicators such as body weight,body length and the incidence of weight growth retardation among 4 groups (all P＞0.05).The incidence of neurobehavioral abnormalities in infants with grade Ⅲ-Ⅳ PIVH was significantly higher than that of infants with grade Ⅰ-Ⅱ PIVH at 12-month correction age (21.05％ vs 3.28％,x2 =4.284,P=0.038).Physical development index(PDI) of grade Ⅰ-Ⅱ PIVH infants was significantly higher than that of grade Ⅲ-Ⅳ PIVH infants at 6-month correction age(F=11.500,P＜0.05).At 12-month correction age,grade Ⅰ-Ⅱ PIVH infants showed a significant higher mental development index(MDI) scores and PDI scores than those of grade Ⅲ-Ⅳ PIVH infants(F=14.227,16.515,all P＜0.05).Of the 80 cases assessed,infants with grade Ⅲ-Ⅳ PIVH had significantly higher rates of cerebral palsy(21.05％ vs 1.64％,x2 =6.300,P=0.012) and developmental delay (26.32％ vs 4.92％,x2=5.185,P=0.023) compared with grade Ⅰ-Ⅱ PIVH infants.Conclusions The severe PIVH can have negative effect on the neurodevelopmental outcomes of preterm infants and might induce mental retardation,cerebral palsy and other neurodevelopmental disabilities.Therefore,the regular follow-up and early intervention in preterm infants with PIVH should be implemented to improve the quality of their lives.