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中国低出生体重早产儿生后 9 个月时校正年龄时的神经心理运动结局与新生儿重症监护病房经口喂养的影响:一项回顾性研究。

Impact of Neonatal Intensive Care Unit oral feeding on neuropsychomotor outcomes at 9 months of corrected age in Chinese low-birthweight preterm infants: A retrospective study.

机构信息

School of Nursing, Shanghai Jiao Tong University, Shanghai, China.

出版信息

J Clin Nurs. 2019 Feb;28(3-4):420-429. doi: 10.1111/jocn.14537. Epub 2018 Jul 27.

Abstract

AIMS AND OBJECTIVES

To examine the changes in neuropsychomotor development and investigate the effect of feeding progression in Neonatal Intensive Care Unit (NICU) on neuropsychomotor outcomes in low-birthweight preterm infants within 9 months of corrected age.

BACKGROUND

Low-birthweight (LBW) preterm infants (<37 weeks of gestation and birthweight <2,500 g) are at a high risk for neuropsychomotor development delay. Therefore, exploring NICU practices related to neuropsychomotor development is important.

DESIGN

This is a retrospective hospital-based cohort study.

METHODS

This study included 196 LBW preterm infants who were admitted to the NICU between January 2014-March 2016 and attended the follow-up growth evaluation in the clinic after discharge. The neuropsychomotor development of preterm infants was assessed every 3 months to a corrected age of 9 months using the paediatric neuropsychomotor diagnostic scale (PNDS). Generalised linear mixed models (GLMM) were performed.

RESULTS

The total PNDS scores had a downward trend, but the difference on pairwise comparison was not statistically significant. In total, 18.1%, 15.2% and 9.7% of preterm infants were examined for neuropsychomotor disorders at 3, 6 and 9 months of corrected age, respectively. The result of GLMM showed that the early initiation of oral feeding with breast milk was associated with optimal neuropsychomotor development. The first 3 months of corrected age is the critical period for neurodevelopmental disorders.

CONCLUSIONS

This study showed the importance of the early initiation of oral feeding with breast milk as early as possible within the NICU setting and highlighted the importance of close developmental follow-up.

RELEVANCE TO CLINICAL PRACTICE

The early initiation of oral feeding with breast milk may be recommended to promote neuropsychomotor development of LBW preterm infants within the NICU setting. Early identification of neuropsychomotor developmental delays within the first 3 months may guide early interventions.

摘要

目的

研究新生儿重症监护病房(NICU)喂养进展对纠正胎龄 9 个月内低出生体重早产儿神经心理运动发育的影响。

背景

低出生体重(LBW)早产儿(<37 周妊娠且出生体重<2500 克)神经心理运动发育迟缓的风险较高。因此,探索与神经心理运动发育相关的 NICU 实践非常重要。

设计

这是一项回顾性基于医院的队列研究。

方法

本研究纳入了 196 名于 2014 年 1 月至 2016 年 3 月期间入住 NICU 并在出院后于门诊接受随访生长评估的 LBW 早产儿。采用儿童神经心理运动诊断量表(PNDS),每 3 个月评估一次早产儿的神经心理运动发育至纠正胎龄 9 个月。采用广义线性混合模型(GLMM)进行分析。

结果

总 PNDS 评分呈下降趋势,但两两比较差异无统计学意义。在纠正胎龄 3、6 和 9 个月时,分别有 18.1%、15.2%和 9.7%的早产儿被检查出神经心理运动障碍。GLMM 的结果表明,尽早开始用母乳喂养是与最佳神经心理运动发育相关的。纠正胎龄前 3 个月是神经发育障碍的关键时期。

结论

本研究表明,在 NICU 环境中尽早开始用母乳喂养对促进 LBW 早产儿的神经心理运动发育非常重要,并强调了密切进行发育随访的重要性。

临床意义

建议在 NICU 环境中尽早开始用母乳喂养,以促进 LBW 早产儿的神经心理运动发育。在头 3 个月内尽早识别神经心理运动发育迟缓可能有助于早期干预。

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