1351例小于胎龄儿在(校正) 6~24月龄神经发育轨迹

Neurodevelopmental Trajectories of 1351 Small for Gestational Age Infants at (Corrected) 6~24 Months of Age

摘要: 目的：探讨小于胎龄儿(small for gestational age, SGA)(校正) 6~24月龄神经心理发育轨迹。方法：收集2018年4月至2023年12月在深圳市宝安区妇幼保健院高危儿随访门诊定期随访的1351例(校正) 6~24月龄SGA儿童随访期间资料，采用《中国0~6岁儿童神经心理行为检查量表(2016版)》评估神经心理发育水平，根据出生胎龄将SGA分为足月儿组、低危早产儿组和高危早产儿组，调查不同胎龄SGA儿童发育商(developmental quotient, DQ)水平并绘制神经发育曲线。结果：各胎龄组SGA的大运动DQ均随月龄增加而上升(P均<0.001)，足月SGA除大运动DQ随时间有提高外(P < 0.001)，其他各能区DQ及总DQ均随时间而下降(P均<0.001)。低危早产SGA的适应能力DQ随月龄增高而升高(P均<0.001)，精细运动、语言和社会行为能区DQ及总DQ随月龄显著下降(P < 0.001)。高危早产SGA除大运动外，其他各能区指标与月龄变化无显著关系(P均>0.05)，精细运动能区DQ一直处于临界偏低状态。在(校正) 6~17月龄，SGA总DQ随着胎龄下降而降低(P均<0.001)，到(校正) 18~24月龄时，低危早产SGA总DQ及其他各能区DQ均与足月SGA无统计学差异(P均>0.05)，而高危早产SGA的总DQ和大运动、精细运动、适应能力DQ均落后于足月SGA (P均<0.05)，大运动DQ落后于低危早产SGA (P = 0.049)。结论：大运动能区为SGA的优势能区；足月和低危早产SGA总DQ随月龄增高而下降，高危早产SGA的总DQ虽然保持稳定，但整体处于较低水平，应加强对34周以下SGA的神经发育管理。

Abstract: Objective: To investigate the neuropsychological developmental trajectory of small for gestational age (SGA) infants during (corrected) 6~24 months of age. Methods: Data were collected during the follow-up period of 1351 cases (corrected) of SGA infants aged 6~24 months who were regularly followed up at the high-risk infant follow-up clinic of Shenzhen Baoan Women’s and Children’s Hospital, Shenzhen, China, from April 2018 to December 2023. Neuropsychological Behavioral Examination Scale for Children 0~6 Years of Age (2016 version) was used to assess the level of neuropsychological development. SGA infants were categorized into full-term, low-risk preterm and high-risk preterm groups according to birth gestational age. The developmental quotient (DQ) levels of SGA infants of different gestational ages were investigated and neurodevelopmental curves were drawn. Results: With the increase of age, DQ values of gross motor in all gestational age groups increased (P < 0.001). Except for the gross motor domain, values of total DQ and other domains in the full-term SGA group were decreased (P < 0.001). DQ values of adaptive ability in low-risk preterm SGA increased with age (P < 0.001), while the fine motor, language and social behavior domains and total DQ decreased (P < 0.001). High-risk preterm SGA infants showed no significant developmental changes across domains (P > 0.05) except for gross motor skills, with the fine motor domain DQ persistently remaining at borderline-low levels. The values of total DQ decreased with the decrease of gestational age during (corrected) 6~17 months of age (P < 0.001). At (corrected) 18~24 months of age, the values of total DQ and each domain DQ between low-risk preterm and full-term SGA infants had no statistical difference (P > 0.05). The total DQ and DQs of gross motor, fine motor and adaptive ability in high-risk preterm SGA infants were all lower than those of full-term SGA infants (P < 0.05), and gross motor DQ was lower than those of low-risk preterm SGA (P = 0.049). Conclusions: The gross motor domain is the predominant developmental area in SGA infants. The total DQ of full-term and low-risk preterm SGA declined with increasing months of age, and the total DQ of high-risk preterm SGA infants remained stable but was at an overall low level, and neurodevelopmental management should be strengthened for SGA below 34 weeks.