早产儿语言-社会行为发育差异的回顾性研究

doi:10.3969/j.issn.1000-8535.2024.09.015

摘要/Abstract

摘要： 目的探讨早产儿语言-社会行为情况及其影响因素,研究语言-社会行为发育与智能发育之间的关系,为早产儿保健提供指导。方法采用自制的一般情况问卷对125例早产儿开展随访、追踪,直至2岁时,采用盖泽尔发展量表（GDS）进行语言-社会行为及智能发育评估。结果早产儿语言发育正常43例（34.4%）,社会行为发育正常40例（32%）。早产儿语言发育商平均为（67.99±25.75）,社会行为发育商平均为（67.75±23.98）,处于发育低下水平。性别、脑出血病史、定期随访史、康复干预史、家庭干预史在语言、社会行为方面比较差异均无统计学意义（P>0.05）。不同胎儿期安胎史、胎龄、出生体质量在语言、社会行为方面比较差异有统计学意义（P<0.05）;且胎儿期反复安胎,胎龄小,出生体质量低,语言及社会行为发育较差。与出生时无中-重度窒息史的患儿相比,出生时有中-重度窒息的患儿存在更多的语言发育异常,比较差异有统计学意义（P<0.05）;但在社会行为发育方面比较差异无统计学意义（P>0.05）。语言-社交行为发育落后的同时,早产儿的大运动、精细动作、适应性行为也存在落后,五大能区比较差异并均有统计学意义（P<0.05）。结论多数早产儿存在语言-社会行为发育落后,其同时可能伴有更多的运动和适应行为发育问题;语言-社交行为发育落后的患儿在胎儿期存在反复安胎且胎龄较小、出生体质量更低或有中-重度窒息史。对早产儿的语言-社会行为要及时给予关注,早期发现并早期干预,改善预后。

关键词: 早产儿, 语言-社会行为发育, 影响因素

Abstract: Objective To explore the language-social behavior of preterm infants and its influencing factors,to study the relationship between language-social behavior development and intellectual development,and to provide guidance for preterm infants' health care．Methods A self-administered general questionnaire was used to follow up 125 preterm infants until the age of 2 years,and Gesell development scale（GDS）was used to assess their language-social behavior and intellectual development．Results Preterm infants had normal language development in 43 cases（34.4%）and normal social behavioral development in 40 cases（32%）．The mean language development quotient of preterm infants was（67.99±25.75）and the mean social behavioral development quotient was（67.75±23.98）,which was at the low developmental level．There were no significant differences in gender,history of cerebral hemorrhage,regular follow-up,rehabilitation intervention,family intervention and language or social behavior（P>0.05）．Infants with different fetal age history,gestational age,and birth weight varied significantly in language and social behavior（P<0.05）;and with repeated miscarriage,small gestational age,low birth weight,showed poor language and social behavior development．Compared the children with and without moderate to severe asphyxia at birth,there was statistically significant differences in language development（P<0.05）,but in social behavior there was no significant difference（P>0.05）．The backward development of language-social behavior was accompanied by backwardness in gross motor,fine motor,and adaptive behavior in preterm infants,and the differences in the five major domains were all present and statistically significant（P<0.05）．Conclusions A major of preterm infants have poor language-social behavior development,which may be accompanied by more motor and adaptive behavior development problems;children with poor language-social behavior development have repeated miscarriage prevention at younger gestational ages,lower birth weights,or a history of moderate-to-severe asphyxia during the fetal period．It is important to give timely attention to language-social behavior in preterm infants for early detection and early intervention to improve prognosis．

Key words: preterm infants, language-social behavior development, influencing factors

李燕君, 成艳玲, 凡伟, 温慧玲, 谭俊杰, 吴文华, 彭琼, 张丽仙. 早产儿语言-社会行为发育差异的回顾性研究[J]. 广州医药, 2024, 55(9): 1054-1059.

LI Yanjun, CHENG Yanling, FAN Wei, WEN Huiling, TAN Junjie, WU Wenhua, PENG Qiong, ZHANG Lixian. A retrospective study of language-social behavior developmental differences in preterm infants[J]. Guangzhou Medical Journal, 2024, 55(9): 1054-1059.

参考文献

[1] 王少雯,陈静静,姚玉佳,等.语言发育迟缓儿童的临床特征分析[J].中国儿童保健杂志,2022,30(11):1254-1257.
[2] WALANI S R.Global burden of preterm birth[J].Int J Gynecol Obstet,2020,150(1):31-33.
[3] SONG I G.Neurodevelopmental outcomes of preterm infants[J].Clin Exp Pediatr,2023,66(7):281-287.
[4] 李琳. 早产儿语言发育迟缓的临床研究[J].中国妇幼卫生杂志,2020,11(1):35-37,51.
[5] 周翔,陈强,陈红,等.Gesell发育量表对2岁内孤独症谱系障碍患儿的应用研究[J].中国儿童保健杂志,2016,24(12):1329-1331.
[6] GUO M,LI L,ZHANG Q,et al.Vitamin and mineral status of children with autism spectrum disorder in Hainan Province of China:associations with symptoms[J].Nutr Neurosci,2020,23(10):803-810.
[7] 邓浩荣. 家庭式康教结合模式对脑瘫儿童发育情况的影响[J].广州医药,2018,49(6):50-53.
[8] 胡瑗,张丽娟,朱鑫荣,等.发育筛查量表联合改良版婴幼儿孤独症筛查量表在孤独症早期筛查中的效果分析[J].中国妇幼保健,2020,35(21):4083-4086.
[9] 黄海燕. 早产儿神经系统发育结局的研究进展[J].中国儿童保健杂志,2016,24(2):153-155.
[10] ALLOTEY J,ZAMORA J,CHEONG-SEE F,et al.Cognitive,motor,behavioural and academic performances of children born preterm:a meta-analysis and systematic review involving 64 061 children[J].BJOG,2018,125(1):16-25.
[11] JOHNSON S,WOLKE D.Behavioural outcomes and psychopathology during adolescence[J].Early Hum Dev,2013,89(4):199-207.
[12] MÅNSSON J,STJERNQVIST K.Children born extremely preterm show significant lower cognitive,language and motor function levels compared with children born at term,as measured by the Bayley-III at 2.5 years[J].Acta Paediatr,2014,103(5):504-511.
[13] ZAMBRANA I M,VOLLRATH M E,SENGPIEL V,et al.Preterm delivery and risk for early language delays:a sibling-control cohort study[J].Int J Epidemiol,2016,45(1):151-159.
[14] ANDESCAVAGE N N,DU PLESSIS A,MCCARTER R,et al.Complex trajectories of brain development in the healthy human fetus[J].Cereb Cortex,2017,27(11):5274-5283.
[15] 刘芳,张文柳,谭丽俊,等.早产对婴幼儿早期语言、睡眠及认知发育影响的探讨[J].中国中西医结合儿科学,2021,13(6):461-464.
[16] 宋金芳. 基于深度学习对晚期早产儿和足月儿的脑发育分析[D].长春:吉林大学,2023.
[17] SILVA C C V,EL MARROUN H,SAMMALLAHTI S,et al.Patterns of fetal and infant growth and brain morphology at age 10 years[J].JAMA Netw Open,2021,4(12):e2138214.
[18] 植自勤,吴劲东,林泉.某院中期早产儿肠外营养及体格发育状况分析[J].广州医药,2020,51(1):39-41,58.
[19] 张怡敏,靳和玥,陶芳标,等.中晚期早产儿不良神经发育结局的研究进展[J].中国儿童保健杂志,2022,30(11):1198-1202.
[20] 陈自励,刘敬,封志纯.新生儿窒息诊断和分度标准建议[J].中国当代儿科杂志,2013,15(1):1.
[21] van BEL F,GROENENDAAL F.Birth asphyxia-induced brain damage:The long road to optimal reduction and prevention！[J].Pediatr Med,2020(3):2020.
[22] NOVAK I,MORGAN C.High-risk follow-up:Early intervention and rehabilitation[J].Handb Clin Neurol,2019(162):483-510.
[23] DeMAURO S B,MERHAR S L,PERALTA-CARCELEN M,et al.The critical importance of follow-up to school age:Contributions of the NICHD Neonatal Research Network[J].Semin Perinatol,2022,46(7):151643.
[24] PASCAL A,GOVAERT P,OOSTRA A,et al.Neurodevelopmental outcome in very preterm and very-low-birthweight infants born over the past decade:A meta-analytic review[J].Dev Med Child Neurol,2018,60(4):342-355.
[25] ABDEYAZDAN Z,EHSANPOUR S,HEMMATI E.Evaluation of growth and development pattern in normal,low and very low birth weight neonates at 18 months of age[J].J Educ Promot,2014(3):102.