Growth and intelligence development among a cohort of low birth weight infants
-
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 
下载: 导出CSV
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
下载: 导出CSV
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
下载: 导出CSV
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。
下载: 导出CSV
-
[1] 吕菊红, 邓峰, 李作良. 低出生体重儿284例相关因素分析[J]. 中国儿童保健杂志, 2002, 10(3): 201-202. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO200203029.htmLYU J H, DENG F, LI Z L. Analysis of related factors in 284 low birth weight infants[J]. Chin J Child Health Care, 2002, 10(3): 201-202. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO200203029.htm [2] 胡勇, 唐军, 夏斌, 等. 1146例极低/超低出生体重儿临床资料分析[J]. 中华妇幼临床医学杂志(电子版), 2017, 13(2): 149-155. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHFY201702006.htmHU Y, TANG J, XIA B, et al. Analysis of clinical data of 1146 very low/very low birth weight infants[J]. Chin J Obstet Gynecol Pediatr (Elect Edit), 2017, 13(2): 149-155. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZHFY201702006.htm [3] 吴运芹, 高喜容, 张琼, 等. 超低/极低出生体重儿出院后早期的生长发育情况[J]. 中华围产医学杂志, 2017, 20(10): 739-745. https://www.cnki.com.cn/Article/CJFDTOTAL-JTHS202102028.htmWU Y Q, GAO X R, ZHANG Q, et al. Early growth and development of VLBW/VLBW infants after discharge[J]. Chin J Perinat Med, 2017, 20(10): 739-745. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-JTHS202102028.htm [4] 江晓阳, 邵子瑜, 孙瑜, 等. 合肥市城区低出生体重儿婴儿期体格发育生长速率的纵向研究[J]. 西部医学, 2021, 33(11): 1647-1654, 1659. doi: 10.3969/j.issn.1672-3511.2021.11.018JIANG X Y, SHAO Z Y, SUN Y, et al. Longitudinal study on the growth rate of physical development during infancy in low birth weight infants in urban areas of Hefei City[J]. Western Med, 2021, 33(11): 1647-1654, 1659(in Chinese) doi: 10.3969/j.issn.1672-3511.2021.11.018 [5] 孙瑜, 邵子瑜, 吴海燕, 等. 2014—2018年合肥市城区活产儿早产发生状况分析[J]. 安徽医学, 2022, 43(6): 720-724. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYX202206024.htmSUN Y, SHAO Z Y, WU H Y, et al. Analysis on the incidence of premature birth of live born infants in urban areas of Hefei from 2014 to 2018[J]. Anhui Med J, 2022, 43(6): 720-724. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-AHYX202206024.htm [6] 冯围围, 黄小娜, 宫丽敏, 等. 2006年世界卫生组织儿童生长标准的研究与应用情况[J]. 中华儿科杂志, 2013, 51(9): 704-707. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-ZJKX200911010056.htmFENG W W, HUANG X N, GONG L M, et al. Research and application of the World Health Organization's child growth standards in 2006[J]. Chin J Pediatr, 2013, 51(9): 704-707. (in Chinese) https://cpfd.cnki.com.cn/Article/CPFDTOTAL-ZJKX200911010056.htm [7] 朱雪娜, 梁爱民, 贾朝霞, 等. 北京市家长用婴幼儿发育迟缓筛查量表的编制研究[J]. 中国儿童保健杂志, 2015, 23(9): 998-1001. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201509034.htmZHU X N, LIANG A M, JIA C X, et al. Research on the development of Beijing Parents' Screening Scale for Infant Stunting[J]. Chin J Child Health Care, 2015, 23(9): 998-1001. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201509034.htm [8] 孔娟, 梁少珍, 陈海凤, 等. 出生早期体重增长速率对早产儿矫正12月龄时神经发育的影响[J]. 中国当代儿科杂志, 2021, 23(3): 236-241. https://www.cnki.com.cn/Article/CJFDTOTAL-DDKZ202103006.htmKONG J, LIANG S Z, CHEN H F, et al. Effect of early birth weight growth rate on neural development of preterm infants at the age of 12 months[J]. Chin J Contemp Pediatr, 2021, 23(3): 236-241. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-DDKZ202103006.htm [9] 张敏, 李萌萌, 杨蕾, 等. 极低/超低出生体重儿0~1岁生长和神经行为发育调查[J]. 中国儿童保健杂志, 2021, 29(3): 249-252. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202103006.htmZHANG M, LI M M, YANG L, et al. Investigation on growth and neurobehavioral development of very low/ultra-low birth weight infants aged 0-1 years[J]. Chin J Child Health Care, 2021, 29(3): 249-252. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202103006.htm [10] CHEN Z, XIONG C, LIU H, et al. Impact of early term and late preterm birth on infants' neurodevelopment: evidence from a cohort study in Wuhan, China[J]. BMC Pediatr, 2022, 22(1): 1-9. [11] MA L, LI X, WANG M, et al. Trends in mortality of low birth weight infants: China, 2004-2019[J]. China CDC Weekly, 2022, 4(20): 431. [12] 孙瑜, 段毓雯, 李玲, 等. 低出生体重儿婴儿期神经精神发育纵向研究[J]. 中国儿童保健杂志, 2018, 26(2): 149-152, 162. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201802012.htmSUN Y, DUAN Y W, LI L, et al. Longitudinal study on neuropsychiatric development of low birth weight infants in infancy[J]. Chin J Child Health Care, 2018, 26(2): 149-152, 162. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201802012.htm [13] 张健, 胡传来, 陶兴永, 等. 低出生体重学龄儿童智力发育状况研究[J]. 中国学校卫生, 2008, 29(8): 695-696. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS200808011.htmZHANG J, HU C L, TAO X Y, et al. Study on the intelligence development of low birth weight school children[J]. Chin J Sch Health, 2008, 29(8): 695-696. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS200808011.htm [14] 姜春花, 黄俊, 李云, 等. 不同出生胎龄低出生体重儿2岁内神经心理发育纵向随访研究[J]. 中国儿童保健杂志, 2021, 29(11): 1228-1232, 1241. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202111019.htmJIANG C H, HUANG J, LI Y, et al. Longitudinal follow-up study on neuropsychological development of low birth weight infants at different birth ages within 2 years[J]. Chin J Child Health Care, 2021, 29(11): 1228-1232, 1241. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO202111019.htm [15] HUMBERG A, HÄRTEL C, PAUL P, et al. Delivery mode and intraventricular hemorrhage risk in very-low-birth-weight infants: observational data of the German neonatal network[J]. Eur J Obstet Gynecol Reprod Biol, 2017, 212: 144-149. [16] 封志纯, 孔祥永. 低出生体重儿的预后及管理[J]. 中国儿童保健杂志, 2018, 26(5): 465-467. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201805001.htmFENG Z C, KONG X Y. Prognosis and management of low birth weight infants[J]. Chin J Child Health Care, 2018, 26(5): 465-467. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201805001.htm [17] MENT L R, VOHR B, ALLAN W, et al. Change in cognitive function over time in very low-birth-weight infants[J]. JAMA, 2003, 289(6): 705-711. [18] UPADHYAY R P, NAIK G, CHOUDHARY T S, et al. Cognitive and motor outcomes in children born low birth weight: a systematic review and Meta-analysis of studies from South Asia[J]. BMC Pediatr, 2019, 19(1): 1-15. (in Chinese) [19] 温晓芳, 邓慧芳, 李俊, 等. 出院低出生体重儿远期神经行为发育的影响因素研究[J]. 中国妇幼保健, 2014, 29(14): 2175-2178. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201414016.htmWENG X F, DEGN H F, LI J. et al. A study on the influencing factors of long-term neurobehavioral development in discharged low birth weight infants[J]. Matern Child Health Care Chin, 2014, 29(14): 2175-2178. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201414016.htm -
点击查看大图
表(4)
计量
- 文章访问数: 281
- HTML全文浏览量: 182
- PDF下载量: 23
- 被引次数: 0
