Growth and intelligence development among a cohort of low birth weight infants
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摘要:
目的 了解低出生体重儿(LBWI)24和36月龄时的生长及智能发育情况，为早期监测和干预低出生体重幼儿的发育提供参考。 方法 选取2012年10月1日—2015年12月30日期间在合肥市医疗保健机构出生及保健管理的LBWI(100名)，同时选取在同一机构进行儿童保健管理的正常出生体重儿(NBWI)作为对照(99名)。采用前瞻性队列研究的方法，在建立队列及儿童期生长发育监测的基础上，按照确定的时点运用统一方法对两组儿童期体格进行纵向随访观察；进一步使用Gesell发育量表对LBWI及NBWI在24及36月龄时进行发育监测。 结果 LBWI幼儿15~36月龄体重、身长、头围等指标均低于NBWI幼儿，差异均有统计学意义(P值均 < 0.05)；117名(43.98%)幼儿完成了智能发育量表的随访评估，其中LBWI 62名，NBWI 55名。在24，36月龄时LBWI幼儿Gesell发育评估中适应性、大运动、精细动作、语言、个人社交各能区评分均低于NBWI(t值分别为-4.17，-3.82，-3.21，-3.03，-2.61；-4.23，-3.16，-3.07，-3.13，-3.99，P值均 < 0.05)。多因素线性回归分析发现，出生体重与24和36月龄的适应性、大运动、精细运动、语言运动能区，以及36月龄个人社交能区均呈正相关(β值分别为0.004，0.010；0.003，0.008；0.003，0.007；0.004，0.009；0.011，P值均＜0.05)。 结论 LBWI幼儿的生长发育明显滞后于NBWI幼儿，LBWI幼儿各能区评分均低于NBWI幼儿，出生体重是影响幼儿智能发育的主要因素。应尽早监测和干预低出生体重儿，避免不良后果出现或减轻不良后果的程度。 Abstract:Objective To explore growth and intelligence development of low birth weight infants (LBWI) at 24 and 36 months of age, so as to provide reference for early monitoring and intervention of the development of LBWI. Methods A total of 100 LBWI born and managed in Hefei Maternal and Child Health Care Institution were selected from 2012 October 1 to 2015 December 30, and 99 normal birth weight infants (NBWI) under child health management in the same sitinstitution were selected as controls. According a prospective cohort study method, and based on the establishment of a cohort and monitoring of childhood growth and development, a unified method was used to longitudinally follow up and observe the physical fitness of two groups of infants at the determined time points. The development of LBWI and NBWI at 24 and 36 months of age was surveyed using the Gesell Development Scale. Results Weight, length and head circumference of LBWI children at the age of 15-36 months were significantly lower than those of NBWI children (P < 0.05). In addition, 117 children (43.98%) completed the full assessment of intelligent development scale, including 62 LBWI and 55 NBWI. The scores of Gesell in NBWI group was higher than that in LBWI group at 24 and 36 months of age, including adaptability, gross motor, fine metor skills, language and personal social functions (t=-4.17, -3.82, -3.21, -3.03, -2.61; -4.23, -3.16, -3.07, -3.13, -3.99, P < 0.05). Multivariate linear regression analysis found that birth weight was positively correlated with adaptability, gross motor, fine motor skills, language functions at 24 and 36 months of age and personal social function at 36 months of age (β=0.004, 0.010; 0.003, 0.008; 0.003, 0.007; 0.004, 0.009; 0.011, P < 0.05). Conclusion The growth and development of LBWI children are significantly delayed compared to NBWI children. The scores of LBWI children are lower than those of NBWI children in all functional areas. Weight is the main factor affecting children's intellectual development. Early monitoring and intervention of low birth weight infants should be carried out to avoid or mitigate adverse consequences. -
Key words:
- Birth weight /
- Growth and development /
- Cohort studies /
- Regression analysis /
- Child
1) 利益冲突声明 所有作者声明无利益冲突。 -
表 1 不同月龄LBWI与NBWI组幼儿体格发育指标比较(x±s)
Table 1. Comparison of physical development indicators between LBWI and NBWI children at different months (x±s)
月龄 组别 人数 统计值 体重/kg 身长/cm 头围/cm 胸围/cm 15 LBWI 100 10.04±1.16 78.0±2.3 46.2±1.4 46.6±1.6 NBWI 99 11.24±1.16 81.1±2.5 47.1±1.2 47.7±1.5 t值 -4.58 -5.93 -4.10 -1.52 P值 < 0.01 < 0.01 < 0.01 0.13 18 LBWI 100 10.83±1.16 81.5±2.4 46.9±1.5 47.1±1.6 NBWI 99 12.02±1.07 84.6±2.4 47.9±1.1 48.7±1.5 t值 -6.42 -6.93 -4.82 -1.30 P值 < 0.01 < 0.01 < 0.01 0.20 21 LBWI 100 11.17±1.37 84.5±2.7 47.1±1.2 47.7±1.9 NBWI 99 12.71±1.20 87.3±3.6 48.4±1.3 49.3±1.9 t值 -5.56 -5.23 -3.51 -3.98 P值 < 0.01 < 0.01 < 0.01 < 0.01 24 LBWI 100 12.05±1.25 87.5±2.5 47.9±1.4 48.8±1.6 NBWI 99 13.46±1.38 90.5±2.7 49.0±1.6 50.4±3.0 t值 -5.02 -6.36 -4.26 -4.74 P值 < 0.01 < 0.01 < 0.01 < 0.01 30 LBWI 100 13.04±1.54 92.0±2.9 48.5±1.4 49.4±2.0 NBWI 99 14.51±1.47 95.2±2.9 49.5±1.1 51.4±1.9 t值 -4.54 -6.11 -4.26 -4.12 P值 < 0.01 < 0.01 < 0.01 < 0.01 36 LBWI 100 14.04±1.83 96.4±3.5 48.9±1.4 50.2±2.7 NBWI 99 15.62±1.82 99.3±3.2 50.1±1.1 52.3±2.1 t值 -4.61 -5.50 -5.57 -4.18 P值 < 0.01 < 0.01 < 0.01 < 0.01 
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表 2 不同月龄LBWI与NBWI组幼儿Gesell发育量表评分比较(x±s)
Table 2. Comparison of scores of Gesell Developmental Scale between LBWI and NBWI children at different months(x±s)
月龄 组别 人数 统计值 适应性 大运动 精细动作 语言 个人社交 24 LBWI 62 96.87±11.11 97.94±6.43 96.83±6.72 92.22±14.93 98.52±11.00 NBWI 55 104.54±8.39 102.03±5.00 101.46±8.80 99.86±11.94 103.05±7.62 t值 -4.17 -3.82 -3.21 -3.03 -2.62 P值 < 0.01 < 0.01 < 0.01 < 0.01 0.01 36 LBWI 62 89.00±14.38 92.06±13.05 93.27±12.71 91.90±19.61 97.13±16.68 NBWI 55 102.06±12.10 101.12±11.79 101.32±9.38 104.25±13.30 110.92±12.60 t值 -4.23 -3.16 -3.07 -3.13 -3.99 P值 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01
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表 3 出生体重对幼儿体格发育影响的多元线性回归分析(n=199)
Table 3. Multivariate linearity analysis of the effect of birth weight on physical development of infants (n=199)
月龄 体重 身长 头围 胸围 β值(95%CI) t值 P值 β值(95%CI) t值 P值 β值(95%CI) t值 P值 β值(95%CI) t值 P值 15 0.001(0.000~0.001) 4.76 < 0.01 0.002(0.001~0.003) 4.66 < 0.01 0.001(0.000~0.001) 4.33 < 0.01 0.002(-0.001~0.004) 1.10 0.27 18 0.001(0.001~0.001) 6.86 < 0.01 0.002(0.002~0.003) 6.87 < 0.01 0.001(0.000~0.001) 5.04 < 0.01 0.001(0.000~0.003) 1.88 0.06 21 0.001(0.001~0.002) 5.74 < 0.01 0.003(0.002~0.004) 4.87 < 0.01 0.001(0.001~0.001) 4.58 < 0.01 0.001(0.001~0.002) 3.81 < 0.01 24 0.001(0.001~0.001) 5.05 < 0.01 0.002(0.002~0.003) 5.88 < 0.01 0.001(0.000~0.001) 4.15 < 0.01 0.001(0.001~0.002) 4.42 < 0.01 30 0.001(0.001~0.001) 5.55 < 0.01 0.002(0.001~0.003) 5.21 < 0.01 0.001(0.000~0.001) 4.59 < 0.01 0.001(0.001~0.002) 4.51 < 0.01 36 0.001(0.001~0.002) 4.54 < 0.01 0.002(0.001~0.004) 4.45 < 0.01 0.001(0.001~0.001) 5.33 < 0.01 0.001(0.001~0.002) 3.55 < 0.01
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表 4 出生体重对婴幼儿智能发育影响的多元线性回归分析(n=199)
Table 4. Multiple linear regression analysis of the effects of birth weight on neuropsychological development of infants (n=199)
发育能区 月龄 模型1 模型2 β值(95%CI) t值 P值 β值(95%CI) t值 P值 适应性 24 0.005(0.003~0.008) 3.97 < 0.01 0.004(0.002~0.007) 3.39 < 0.01 36 0.011(0.006~0.016) 4.53 < 0.01 0.010(0.006~0.015) 4.50 < 0.01 大运动 24 0.003(0.001~0.004) 3.72 < 0.01 0.003(0.001~0.004) 3.21 < 0.01 36 0.008(0.004~0.013) 3.79 < 0.01 0.008(0.004~0.012) 3.64 < 0.01 精细运动 24 0.003(0.001~0.005) 2.76 0.01 0.003(0.001~0.005) 2.46 0.02 36 0.007(0.002~0.011) 3.22 < 0.01 0.007(0.003~0.011) 3.36 < 0.01 语言 24 0.005(0.001~0.008) 2.51 0.01 0.004(0.000~0.007) 2.05 0.04 36 0.010(0.004~0.016) 3.27 < 0.01 0.009(0.003~0.015) 3.13 < 0.01 个人社交 24 0.003(0.001~0.006) 2.37 0.02 0.002(0.000~0.005) 1.79 0.08 36 0.012(0.006~0.017) 4.34 < 0.01 0.011(0.006~0.017) 4.02 < 0.01 注：模型1未调整协变量，模型2调整母亲年龄、父母文化程度、家庭收入。
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