目的 探讨合并脑损伤高危因素的小于胎龄儿的早期运动发育特点.方法 回顾性纳入2022年2～10月在西安市儿童医院新生儿随访门诊随访,合并脑损伤高危因素且在校正年龄(corrected age,CA)2～5周或CA14～17周随访并完成一次婴儿运动能力测试(Test of Infant Motor Performanc,TIMP)的小于胎龄儿(small for gestational age,SGA)和适于胎龄 儿(appropriate for gestational age,AGA)共 81 例.CA2～5 周随访到 SGA 17例(SGA组),AGA 24例(AGA组);CA14～17周随访到SGA 20例(SGA组),AGA 20例(AGA组).采用两独立样本t检验、秩和检验及x2检验比较组间的人口学特征、脑损伤高危因素及TIMP各项评分的差异.结果 CA2～5周和CA14～17周,SGA组的出生体重均低于AGA组[(1 817.1±440.3)与(2 630.0±560.9)g,t=-4.98;(1 752.0± 434.4)与(2 226.3±699.8)g,t=-2.58;P值均＜0.05],但2组的出生胎龄、脑损伤高危因素差异均无统计学意义(P值均＞0.05).(1)CA2～5 周:SGA组 TIMP 原始总分[(71.6±13.7)与(80.5±11.5)分,t=-2.26,P=0.029]、引出项评分[61.0 分(41.0～85.0 分)与 69.1 分(49.0～96.0 分),Z=-2.15,P=0.037]和坐位[8.8 分(3.0～19.0 分)与 11.2 分(5.0～22.0 分),Z=-2.07,P=0.038]、俯卧位评分[(9.8±3.1)与(12.3± 3.1)分,t=-2.19,P=0.034]均低于AGA组.(2)CA14～17周:SGA组患儿的TIMP站立位评分低于AGA组[6.5分(4.0～11.0分)与7.7分(2.0～11.0分),Z=-2.05,P=0.040],但原始总分及坐位、仰卧位、俯卧位、翻身、侧方位各体位评分组间差异均无统计学意义(P值均＞0.05).结论 5月龄前,SGA的早期运动能力较AGA低,在CA2～5周主要表现为头控能力相对落后,在CA14～17周时头控能力落后延续至站立位.
Early motor development in small for gestational age infants at high risk of brain injury
Objective To investigate the characteristics of early motor development in small for gestational age(SGA)infants at high risk of brain injury.Methods This study retrospectively enrolled a total of 81 SGA infants and appropriate for gestational age(AGA)infants who were at high risk of brain injury and attended outpatient follow-up visits in Xi'an Children's Hospital from February to October 2022.Seventeen SGA infants(SGA group)and 24 AGA infants(AGA group)were assessed for motor development using the Test of Infant Motor Performance(TIMP)at 2-5 weeks of corrected age(CA)and 20 SGA infants(SGA group)and 20 AGA infants(AGA group)were assessed at 14-17 weeks of CA.Independent samples t-test,rank-sum test,and Chi-square test were used to compare the demographic characteristics,high-risk factors of brain injury,and TIMP scores between the two groups.Results At 2-5 weeks and 14-17 weeks of CA,the birth weights of SGA group were both less than those of AGA group[(1 817.1±440.3)vs.(2 630.0±560.9)g,t=-4.98;(1 752.0±434.4)vs.(2 226.3±699.8)g,t=-2.58;both P＜0.05],but there were no significant differences in gestational age at birth or high-risk factors of brain injury between the two groups(all P＞0.05).(1)At 2-5 weeks of CA:SGA group had lower total TIMP score[(71.6±13.7)vs.(80.5±11.5)scores,t=-2.26,P=0.029],elicited item score[61.0 scores(41.0-85.0 scores)vs.69.1 scores(49.0-96.0 scores),Z=-2.15,P=0.037],sitting position score[8.8 scores(3.0-19.0 scores)vs.11.2 scores(5.0-22.0 scores),Z=-2.07,P=0.038],and prone position score[(9.8±3.1)vs.(12.3±3.1)scores,t=-2.19,P=0.034]when compared with AGA group.(2)At 14-17 weeks of CA:The standing position score of the SGA group was lower than that of the AGA group[6.5 scores(4.0-11.0 scores)vs.7.7 scores(2.0-11.0 scores),Z=-2.05,P=0.040],but no statistical difference was observed in the total TIMP score or the scores of sitting,supine,prone,turning,and lateral positions between the two groups(all P＞0.05).Conclusion Early motor performance of SGA infants is inferior to AGA infants before five months of age,which is embodied in the poor head control at 2-5 weeks of CA that further affects the stability of standing posture in them at 14-17 weeks of CA.
Brain injuriesInfant,small for gestational ageFetal growth retardationNeurodevelopmental disordersMotor skills
简茹、张慧平、卜婧愉、袁飒、陈艳妮
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西安交通大学医学部,西安 710061
西安交通大学附属儿童医院(西安市儿童医院)新生儿重症医学科,西安 710002
空军军医大学唐都医院儿科,西安 710038
三二〇一医院儿童保健科,汉中 723000
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脑损伤 婴儿,小于胎龄 胎儿生长迟缓 神经发育障碍 运动技能
国家自然科学基金陕西省重点研发计划陕西省重点研发计划陕西省科学技术研究发展计划西安市科技计划项目陕西中医药大学中西医结合防治脑发育障碍性疾病创新团队上海申康医院发展中心临床三年行动计划Xi'an Science and Technology Plan Project
NETL
NSTL
万方数据
维普
