上海市低出生体重儿18月龄神经行为发育相关因素分析

Factors related to neurobehavioral development in 18-month-old infants with low birth weight in Shanghai

  • 摘要:
    目的 探讨影响低出生体重儿(LBW)神经行为发育的相关因素,为早期识别高危儿神经行为发育异常提供科学依据。
    方法 收集2018年1—10月上海市16个区妇幼保健院(所)进行健康系统管理的LBW,对符合纳入及排除标准的对象进行问卷调查、体格生长测量、Gesell发育诊断评估。
    结果 共纳入885例入选研究对象进行分析。其中,男童400例(45.2%),女童485例(54.8%);32例(3.6%)出生体重<1 500 g,853例(96.4%)出生体重1 500~2 500 g。LBW 18月龄大动作、精细动作、适应行为、语言和个人-社交行为发育异常率(发育商≤85分)分别占3.3%、10.3%、15.7%、22.1%、14%。性别、出生体重、胎龄作为混杂因素调整后进行多因素分析发现,男性是LBW精细动作发育异常(OR=1.86,95%CI:1.19~2.90)和个人-社交行为发育异常(OR=1.69,95%CI:1.14~2.50)的危险因素;胎龄<32周是个人-社交行为发育异常的危险因素(OR=4.95,95%CI:2.08~11.79);孕期情绪紧张是大动作发育异常(OR=3.3,95%CI:1.33~8.21)、语言发育异常(OR=1.72,95%CI:1.03~2.88)和个人-社交行为发育异常(OR=2.72,95%CI:1.56~4.72)的危险因素;孕期香烟烟雾暴露是精细动作发育异常(OR=5.52,95%CI:2.07~14.70)和适应行为发育异常(OR=2.88,95%CI:1.12~7.43)的危险因素;孕期糖尿病是语言发育异常的危险因素(OR=2.22,95%CI:1.12~4.42);妊娠高血压综合征是个人-社交行为发育异常的危险因素(OR=3.57,95%CI:1.86~6.83);小头围(头围Z积分<-2)是大动作(OR=16.15,95%CI:3.05~85.69)、精细动作(OR=11.17,95%CI:1.15~108.83)、语言发育异常的危险因素(OR=7.86,95%CI:1.45~42.57)。
    结论 LBW神经行为发育与性别、胎龄、孕期情绪、孕期香烟烟雾暴露、孕期疾病及头围发育相关,因此避免孕期不良环境暴露、积极防治妊娠期并发症、重视头围随访和积极预防早产对LBW神经行为发育具有一定程度的保护意义。

     

    Abstract:
    Objective To explore the factors affecting neurobehavioral development of 18-month-old infants with low birth weight (LBW), and to provide scientific basis for early identification of neurobehavioral abnormalities.
    Methods The information of LBW infants who required follow-up in maternal and child health care institutions of 16 districts in Shanghai from January to October 2018 was collected. The subjects who met the inclusion and exclusion criteria were investigated by questionnaire, physical growth measurement and Gesell development diagnosis evaluation.
    Results A total of 885 qualified subjects were included in this study, including 400 boys (45.2%), 485 girls (54.8%), 32 cases with birth weight <1 500 g (3.6%), and 853 cases with birth weight ranging from 1 500 g to 2 500 g (96.4%). The percentage of abnormalities in the LBW infants at 18 months was 3.3% for gross-motor, 10.3% for fine-motor, 15.7% for adaptive behaviors, 22.1% and 14% for language and personal-social behaviors (DQ≤85), respectively. Multivariate analysis, with gender, birth weight and gestational age adjusted as confounding factors, showed the following risk factors: male for LBW fine-motor dysplasia (OR=1.86, 95%CI: 1.19‒2.90) and personal-social behavior dysplasia (OR=1.69, 95%CI: 1.14‒2.50); gestational age less than 32 weeks for personal-social behavior dysplasia (OR=4.95, 95%CI: 2.08‒11.79); stress during pregnancy for gross- motor dysplasia (OR=3.3, 95%CI: 1.33‒8.21), language dysplasia (OR=1.72, 95%CI: 1.03‒2.88) and personal-social behavior dysplasia (OR=2.72, 95%CI: 1.56‒4.72); cigarette smoke exposure during pregnancy for fine-motor dysplasia (OR=5.52, 95%CI: 2.07‒14.70) and adaptive behavior dysplasia (OR=2.88, 95%CI: 1.12‒7.43); gestational diabetes for language dysplasia (OR=2.22, 95%CI: 1.12‒4.42); pregnancy induced hypertension (PIH) for abnormal personal-social behavior development (OR=3.57, 95%CI: 1.86‒6.83); and small head circumference (HCZ<-2) for gross-motor dysplasia (OR=16.15, 95%CI: 3.05‒85.69), fine-motor dysplasia (OR=11.17, 95%CI: 1.15‒108.83) and language dysplasia (OR=7.86, 95%CI: 1.45‒42.57).
    Conclusion The neurobehavioral development of LBW infants is related to gender, gestational age, mood during pregnancy, cigarette smoke exposure during pregnancy, diseases during pregnancy and head circumference development. Thus, avoiding adverse environmental exposure during pregnancy, actively preventing complications during pregnancy, paying attention to head circumference follow-up and prevention of preterm delivery are of protective significance to the neurobehavioral development of low birth weight infants.

     

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