Tian Yuan, Zhang Chuncao, Liu Feng, Hong Xia, Shen Li, Chen Jinjin, Jiang Haifeng
Department of Child Health Care, Shanghai Children's Hospital, Shanghai, China.
Department of Planning and Development Office, Shanghai Children's Hospital, Shanghai, China.
Gen Psychiatr. 2025 Jan 21;38(1):e101634. doi: 10.1136/gpsych-2024-101634. eCollection 2025.
There have been numerous intervention studies focusing on the development of preterm infants, but there has been limited investigation into the home environment as a determinant of developmental outcomes in preterm infants. The aspects and extent to which the home environment affects the early (18 months corrected age) neuropsychological development of preterm infants are still unclear.
This study aimed to analyse the effect of the home environment on the neuropsychiatric development of preterm infants at 18 months corrected age after discharge from the neonatal intensive care unit (NICU). It also sought to provide a basis for promoting neuropsychiatric development among preterm infants by improving the home environment.
In this retrospective cross-sectional study, 275 preterm infants born between January 2019 and January 2022 were followed up for systematic management after discharge from the NICU at Shanghai Children's Hospital. The Home Nurture Environment Questionnaire was used to assess the home environment of the infants and analyse its impact on the developmental quotient (evaluated by the Gesell Developmental Scale) and the rate of developmental delays at 18 months corrected age.
A total of 41.454% of the infants were extremely preterm. The developmental quotient scores at 18 months corrected age were in the middle of the scale. The language domain had the highest rate of developmental delay (46.182%), followed by the adaptive domain (37.091%). Multiple logistic regression analyses showed that compared with infants in supportive home environments, infants with moderate/unsupportive home environments had significantly elevated risks of development delay: 2.162-fold for global (odds ratio (OR) 2.162, 95% confidence interval (CI) 1.274 to 3.665, p=0.004), 2.193-fold for fine motor (OR 2.193, 95% CI 1.161 to 4.140, p=0.016), 2.249-fold for language (OR 2.249, 95% CI 1.336 to 3.786, p=0.002) and 2.042-fold for personal-social (OR 2.042, 95% CI 1.149 to 3.628, p=0.015).
A supportive home environment is a crucial protective factor for the neuropsychological development of preterm infants. It is associated with higher developmental quotient scores and protects against neuropsychiatric delays. Incorporating evaluation and continuous improvement of the home environment into the management framework for preterm infants to promote optimal neurodevelopment is essential.
已有众多干预研究聚焦于早产儿的发育情况，但对于家庭环境作为早产儿发育结局的决定因素的研究却很有限。家庭环境影响早产儿早期（矫正年龄18个月）神经心理发育的方面和程度仍不明确。
本研究旨在分析家庭环境对新生儿重症监护病房（NICU）出院后矫正年龄18个月的早产儿神经精神发育的影响。同时，本研究还旨在通过改善家庭环境为促进早产儿神经精神发育提供依据。
在这项回顾性横断面研究中，对2019年1月至2022年1月期间出生的275名早产儿在上海儿童医院NICU出院后进行系统管理随访。采用家庭养育环境问卷评估婴儿的家庭环境，并分析其对矫正年龄18个月时发育商（由格塞尔发育量表评估）及发育迟缓率的影响。
共有41.454%的婴儿为极早产儿。矫正年龄18个月时的发育商得分处于量表中等水平。语言领域的发育迟缓率最高（46.182%），其次是适应领域（37.091%）。多项逻辑回归分析显示，与家庭环境支持性较好的婴儿相比，家庭环境为中等/支持性较差的婴儿发育迟缓风险显著升高：整体发育迟缓风险升高2.162倍（优势比（OR）2.162，95%置信区间（CI）1.274至3.665，p = 0.004），精细运动发育迟缓风险升高2.193倍（OR 2.193，95% CI 1.161至4.140，p = 0.016），语言发育迟缓风险升高2.249倍（OR 2.249，95% CI 1.336至3.786，p = 0.002），个人 - 社会能力发育迟缓风险升高2.042倍（OR 2.042，95% CI 1.149至3.628，p = 0.015）。
支持性的家庭环境是早产儿神经心理发育的关键保护因素。它与较高的发育商得分相关，并可预防神经精神发育迟缓。将家庭环境的评估与持续改善纳入早产儿管理框架以促进最佳神经发育至关重要。
