早期新生儿行为神经评分的影响因素分析及干预对策

摘要

目的：探讨早期影响新生儿行为神经评分（NBNA ）的因素，并提出相应的干预对策。方法选取新生儿368例，根据NBNA结果分为正常组297例和异常组71例。对2组新生儿资料及母亲孕产期状况进行统计和分析。结果 NB-NA正常组新生儿重度缺氧缺血性脑病、胆红素水平＞257μmol/L者明显少于NBNA异常者，母亲在妊娠期合并糖尿病及有重大心理应激者明显少于NBNA异常者，分娩时NBNA正常组羊水胎粪污染者明显少于NBNA异常组，差异有统计学意义（P＜0.05）。2组新生儿性别、母亲产前应用激素差别无统计学意义（P＞0.05）。NBNA正常新生儿1 min、5 min及10 min Apgar评分均明显高于NBNA异常者，2组比较差异有统计学意义（P＜0.05）。2组新生儿胎龄和出生体质量差别无统计学意义（P＞0.05）。经Logistic回归分析，新生儿重度缺氧缺血性脑病、胆红素水平＞257μmol/L、Apgar评分水平、母亲孕期合并糖尿病或经受重大心理应激均是导致新生儿行为神经评分异常的独立危险因素（ P＜0.05）。结论早期影响新生儿行为神经评分因素多样，在临床工作中应从孕期开始，给予孕产妇全面检查，早期进行身心两方面干预，对于存在高危因素的新生儿，应早期给予补救干预，尽量减少危险因素对新生儿的影响，从而改善新生儿预后。%Objective To investigate the factors that influence early neonatal behavioral neurological assessment (NBNA) and propose appropriate intervention countermeasures .Methods 368 cases of newborns ,according to NBNA results were di-vided into normal group (n=297) and abnormal group (n=71) .Neonatal data and mothers’ situation of the two groups were analyzed .Results Newborns with severe hypoxic-ischemic encephalopathy ,bilirubin levels > 257μmol/L in NBNA normal group were significantly less than those of NBNA abnormal group ,the mother with diabetes during pregnancy and significant psychological stress were significantly less than those in NBNA abnormal group ;Newborns polluted by meconium in NBNA normal group were significantly less than the polluters in NBNA abnormal group ,the difference was statistically significant (P<0.05). The difference in neonatal gender was not significant ;the difference of the mothers who used hormone in the antepar-tum was not significant (P>0.05). Apgar scores of NBNA normal newborns at 1min ,5min and 10min were significantly high-er than those of NBNA abnormal group ,the difference was significant(P<0.05). The difference in gestational age and birth weight of newborns between two groups was not statistically significant (P>0.05). Logistic regression analysis showed that severe neonatal hypoxic-ischemic encephalopathy ,bilirubin levels>257μmol/L ,Apgar score level ,mothers with diabetes dur-ing pregnancy or subjected to psychological stress were significantly independent risk factors which resulted in neonatal behav-ioral neurological abnormality (P<0.05). Conclusion The factors that influence early neonatal behavioral neurological assess-ment are diverse ,in clinical work a comprehensive examination should be given to the pregnant women during pregnancy ,phys-ical and psychological aspects of early intervention should be taken ,early remedial interventions should be given to minimize the impact on neonatus ,and thereby improve the prognosis of neonatus .