影响早产儿行为神经测定因素的分析

目的 探讨新生儿行为神经测定(NBNA)在早产儿的应用及影响其评估指标的因素.方法 选择2006年1月至2007年6月在我院新生儿科住院治疗的123例早产儿,分别在纠正胎龄40周时进行NBNA评分,分析胎龄、出生体重、是否机械通气以及机械通气时间、围生期是否有致脑损伤的高危因素对NBNA评分的影响.结果 胎龄<30周、～32周、～34周早产儿及出生体重<1 250 g、～1 500 g、～2 000 g早产儿NBNA评分差异均具有显著性(P<0.01),胎龄越低、出生体重越低,NBNA评分越低;需机械通气的早产儿NBNA评分明显低于未上呼吸机者(P<0.01),机械通气时间＞7 d NBNA评分明显低于＜7 d者(P<0.05);围生期有出血性和缺血性脑损伤、间接胆红素≥256.5 μmol/L、血糖反复<2.6 μmol/L、发生感染者NBNA评分明显降低(P<0.01);臀位、钳产、吸引产早产儿NBNA评分明显低于剖宫产和顺产者(P<0.01);Apgar评分为0～3分者NBNA评分明显低于4～7分和≥8分者(P<0.01).结论 胎龄、出生体重、是否机械通气、机械通气时间、异常的分娩方式、合并重度窒息均影响早产儿的NBNA评分.对于早产儿,特别是胎龄<32周,出生体重<1 500 g,存在致脑损伤高危因素的早产儿,生后3～7 d内应行头颅B超检查,及早发现颅内病变,尽早干预,减少后遗症的发生.

Influence factors of the neonatal behavioral neurological assessment in premature infant

Objective To explore the application of neonatal behavioral neurological assessment (NBNA) in premature infant and the influence factors.Methods One handred and twenty-three premature neonates hospitalized in our neonatal department from January 2006 to June 2007 were enrolled in the study.The NBNA was carried out at corrected conceptus age 40w.The influence of conceptus age,birth weight,mechanical ventilation and the ventilation time,high risk factors of brain damage in perinatal period,different delivery methods,and the Apgar score on the outcome of NBNA were analyzed.Results There were significant differences of the NBNA results among the premature infants with different conceptus age (<30w,～32w,and ～34w) and birth weight (<1250g,～1500g,and ～2000g) (P<0.01).The NBNA score was lower as the neonate was younger with conceptus age and lower with birth weight.The NBNA scores in the neonates with ventilation and ventilation time more than 7d were obviously lower than that without ventilation (P<0.01)and ventilation time less than 7d (P<0.05).Furthermore the NBNA scores were markedly lower when the neonates complicated with hemorrhagic and ischemic brain damage,conjugated bilirubin ≥256.5μmol/L,hypoglycemia (<2.6μmol/L) and infection(P<0.01).And the NBNA in neonates with breech position,obstetrical forceps and vaccum extraction delivery was obviously lower than that in the cesarean delivery and spontaneous delivery (P<0.01).The neonate with Apgar score between 0 and 3 has lower NBNA in compared with those with Apgar score 4-7 and ≥8 (P<0.01).Conclusion There are many factors affecting on the NBNA outcome,such as conceptus age,birth weigh,ventilation and ventilation time,abnormal delivery methods,and severe asphyxia.In order to find intracalvarium pathological changes and give early intervention,decrease additional damage and sequelae,the skull ultrasound should be carried out at 3 to 7d after birth for the premature neonate,especially those whose conceptus age less than 32w and birth weight no more than 1500g or with high risk factors of brain damage.