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合并暂时性低甲状腺素血症早产儿体格和神经心理发育监测

Monitor of physical and neurological development among premature infants with transient hypothyroxinemia

    摘要
  • 摘要:
    目的 探讨早产儿暂时性低甲状腺素血症（transient hypothyroxinemia of premature，THOP）对早产儿体格发育和神经心理发育的影响。
    方法 收集2019年5月 — 2021年9月江西省妇幼保健院收治的 < 34周早产儿且出生后4周内接受过甲状腺功能检测的患儿资料，根据甲状腺功能分为THOP组和对照组，比较两组体格发育和神经心理发育水平的差异。体格发育评价使用Z值评价，神经心理发育评价采用新生儿行为神经测定方法（neonatal behavioral neurological assessment，NBNA），矫正0 ~ 28 d，> 35 分为正常） 、0 ~ 6岁儿童智能发育筛查测验（developmental screening test for child under six，DST）和Gesell 发育诊断量表，后二者均以发育商（development quotient，DQ） ≥ 85分为正常。
    结果 THOP组和对照组矫正15月龄内完成2次以上出院后随访的例数分别为74例和75例。THOP组胎龄和出生体重均低于对照组［（29.2 ± 3.0）周 vs.（31.1 ± 1.6）周，（1 259.0 ± 292.0）g vs.（1 511.0 ± 285.0）g］，差异均有统计学意义（均P < 0. 001）。THOP组矫正8月龄前年龄的身长Z值低于对照组，矫正9 ~ 15月龄时两组体格发育的比较差异无统计学意义（P > 0.05）；28 d内THOP组有2例早产儿NBNA评分异常（分别为34分和35分），对照组NBNA评分均 > 35分；THOP组矫正3 ~ 8月龄时DQ异常率高于对照组（36.6% vs. 14.3%），但矫正9 ~ 15月龄时两组的比较差异无统计学意义（P > 0.05）。
    结论 THOP对早产儿9 ~ 15月龄体格和神经心理发育无显著影响，THOP 可能不是影响早产儿体格和神经心理发育的主要原因。

     

    Abstract:
    Objective To explore the influence of transient hypothyroxinemia of premature (THOP) on their physical and neurological development.
    Methods A retrospective medical records review of preterm infants with gestational ages (GA) < 34 weeks who were admitted to Jiangxi Provincial Maternal and Child Health Hospital and underwent initial thyroid function tests within 4 weeks postnatal were recruited as study subjects from May 2019 to September 2021. Their clinical information was collected. They were divided into THOP group and control group based on their thyroid function. Physical and neurological development were compared between 2 groups. Z score was used to evaluate physical developement. Neonatal behavioral neurological assessment (NBNA) (corrected age 0 − 28 days, score > 35 is normal), DST (developmental screening test for child under six), and Gesell developmental test scale were used to evaluate neurological development. Development quotient (DQ) ≥ 85 was normal for DST and Gesell test.
    Results Seventy-four in THOP group and 75 in control group finished followed up more than twice within the corrected age of 15 months. THOP group had significantly lower gestational age and birth weight compared with control group (29.2 ± 3.0 weeks vs. 31.1 ± 1.6 weeks, 1 259 ± 292 g vs. 1 511 ± 285 g, all P < 0.001). The length for age Z-score of THOP group was lower than that of control group within corrected age of 8 months, but there was no significant difference in physical development between 2 groups at corrected age of 9 − 15 months (P > 0.05). Two cases were found NBNA score (34 and 35) abnormal in THOP group within 28 days, but NBNA score were all > 35 in control group. The percentage of abnormal DQ in THOP group was higher than that in control group（36.6% vs. 14.3%）at corrected age of 3 − 8 months, but there was no significant difference between 2 groups at 9 − 15 months of corrected age (P > 0.05).
    Conclusion THOP has no significant effect on physical and neurological development in preterm infants at the age of 9 − 15 months. THOP might not be the main cause that affecting physical and neurological development of preterm infants.

     

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