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坏死性小肠结肠炎对52例早产儿神经发育的影响

Effect of necrotizing enterocolitis on neurodevelopment among 52 premature infants

    摘要
  • 摘要:
    目的 了解坏死性小肠结肠炎（necrotizing enterocolitis，NEC）及其严重程度对早产儿远期神经发育的影响，以期为早产儿神经发育障碍的诊治提供参考。
    方法 采用前瞻性队列研究，选取2018年1月— 2021年11月收治于泉州市儿童医院的NEC早产儿52例、非NEC早产儿104例为研究对象，应用Gesell发育量表在幼儿期评估其神经发育水平，将发育商（development quotient，DQ） ≤ 85定义为神经发育异常。分析NEC早产儿与非NEC早产儿的神经发育异常发生率以及体格发育情况等指标。
    结果 在矫正25（20，28）月龄时，NEC组的年龄别身高Z评分低于非NEC组− 0.75（− 1.58，0.03） vs. − 0.17（− 0.84，0.38），P = 0.01，神经发育异常发生率明显高于非NEC组（67.3% vs.35.6%，P < 0.001），DQ低于非NEC组84（80，89）vs. 87（82，93），P = 0.01。NEC组大运动及精细运动的评分均低于非NEC组88（77，94） vs. 92（85，96），P = 0.03；89（83，96） vs. 93（87，100），P = 0.01。NEC组中的外科组25例早产儿和内科组27例早产儿的体格发育比较差异无统计学意义（P > 0.05），但外科组早产儿神经发育异常发生率高于内科组早产儿（88.0% vs.48.0%，P < 0.05）。外科组合并短肠综合征（short bowel syndrome，SBS）的4例患儿和未合并SBS的21例患儿的体格发育和神经发育异常发生率比较差异均无统计学意义（均P> 0.05），但前者的DQ低于后者75（62，77） vs. 83（81，85），P < 0.05。
    结论 NEC早产儿出现神经发育异常的风险高于非 NEC早产儿，且异常发生率较高。NEC越严重，不良神经发育结局的风险越高。

     

    Abstract:
    Objective  To investigate the effects of necrotizing enterocolitis (NEC) and its degree of severity on long-term neurodevelopment, in order to provide evidence for early diagnosis and intervention of neurodevelopmental impairment among premature infants.
    Methods  A prospective cohort study was conducted. 52 NEC and 104 non-NEC preterm infants admitted to Quanzhou Children's Hospital were recruited as study subjects from Jan, 2018 to Nov, 2021. Gesell developmental scale was used to assess neurodevelopment at toddler's age. The development quotient (DQ) ≤ 85 was defined as neurodevelopmental impairment.The incidence of neurodevelopmental abnormalities and physical development between NEC and non-NEC preterm infants were analyzed.
    Results  At corrected age of 25(20,28) months, height-for-age Z-score in the NEC group was significantly lower than that in the non-NEC group − 0.75(− 1.58,0.03) vs. − 0.17(− 0.84,0.38), P = 0.01. The incidence of neurodevelopmental impairment in NEC group was higher than that in non-NEC group (67.3% vs. 35.6%, P < 0.001). The total DQ, gross motor DQ and fine motor DQ in NEC group were lower than those in non-NEC group 84(80,89) vs. 87(82,93), P = 0.01; 88(77,94) vs. 92(85,96), P = 0.03; 89(83,96) vs. 93(87,100), P = 0.01. There was no significant difference in physical development between surgical (n = 25) and internal medical group (n = 27) within NEC group (P > 0.05), but the incidence of neurodevelopmental impairment in the surgical group was significantly higher than that in the internal medical group (88.0% vs. 48.0%, P < 0.05). Within the surgical group, there was no significant difference in physical development and neurodevelopmental impairment between the NEC with short bowel syndrome (SBS) group (n = 4) and NEC without SBS group (n = 21) (P > 0.05), but the DQ in the NEC with SBS group was lower than that in NEC without SBS group 75(62,77) vs. 83(81,85), P < 0.05.
    Conclusion  The risk of neurodevelopmental abnormalities is higher in NEC survivors than that in non-NEC. The higher severity degree of the NEC, the higher risk of the adverse neurodevelopmental outcomes.

     

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