[Lowering incidence of cerebral palsy of premature infants through early intervention].
[Lowering incidence of cerebral palsy of premature infants through early intervention].
复制标题
早期干预降低早产儿脑瘫发生率
DOI：
10.1016/j.ejogrb.2016.03.048
复制
发表时间：
2005
期刊：
影响因子：
--
通讯作者：
X. Bao
中科院分区：
文献类型：
--
作者：
X. Bao
客观化
近年来，早产儿的存活率有所提高，但脑性瘫痪的发生率不仅没有下降，反而有上升的趋势。1997年对中国7省30,000余名1~6岁儿童调查，早产儿脑性瘫痪发病率为29.13‰，是足月儿的25.16倍。中国每年约有100万早产儿出生，其中可能包括增加约2.9万名脑瘫婴儿。脑性瘫痪婴幼儿康复费用高，老年患者无法治愈，只有提高生活质量才有可能。因此，我们从2000年3月1日至2003年2月底开展了这项研究，以探讨早期干预在降低早产儿脑性瘫痪发生率中的作用。
方法
将1053例存活的胎龄在37周以下的早产儿分为早期干预组(551例)和常规护理组(502例)，排除先天畸形和遗传性代谢性疾病。分类方法：所有在研究开始前1年内出生的早产儿和研究开始后出生的父母不愿接受早期干预的早产儿纳入常规护理组；所有在研究开始后出生的早产儿其家庭打算积极参与早期干预的纳入干预组。在每个协作单元中，两组的婴儿数量相当接近。干预组在常规护理的基础上，对早产儿出院后进行早期干预，纠正年龄前每月干预1次，矫正年龄6个月后每2个月干预1次。指导父母培养婴儿的认知、语言、情感和沟通能力，并对婴儿进行按摩、锻炼和主动运动训练。所有有运动异常表现的婴儿均给予适当的康复训练。在常规护理组，婴儿只接受类似的常规护理。
结果
两组在孕母并发症、平均胎龄和出生体重、小于胎龄(SGA)、单胎和多胎比例、胎儿应激、出生后窒息、新生儿缺氧缺血性脑病(HIE)和颅内出血发生率、新生儿行为神经功能评分等方面差异无统计学意义(P>；0.05)。这些都表明，这两组人具有可比性。1岁时干预组脑性瘫痪发生率为0.91%(5/551)，常规护理组为3.19%(16/502)(P<；0.01)。干预组脑性瘫痪5例，轻度3例，重度2例。常规护理组16例中，中度7例，重度9例。
结论
早期干预可降低早产儿脑性瘫痪的发生率。这一结论有待更大样本量的研究证实。
OBJECTIVE
In recent years, the survival rate of premature infants is increased, but the incidence of cerebral palsy did not decrease, instead, there was a tendency of increase. The incidence of cerebral palsy of premature infants was 29.13 per thousand in 7 provinces in China in an investigation of over 30,000 children 1 - 6 years of age in 1997, which is 25.16 times higher than that of full term infants. Each year, about 1 million premature infants are born in China, which may include an increase of approximately 29,000 cerebral palsy infants. The rehabilitation expense of cerebral palsy infants is high, older patients cannot be cured; only improved life quality is possible. Therefore, we carried out this research from March 1, 2000 to the end of February 2003 to explore the effects of early intervention in lowering the incidence of cerebral palsy among premature infants.
METHODS
A total of 1053 cases of survived premature infants, gestational age under 37 weeks, excluding those with congenital deformity and hereditary metabolic diseases, born or treated in all collaborative units were classified into 2 groups: early intervention group (551 cases) and routine care group (502 cases). Method of classification: all premature infants born within 1 year before beginning of the study and premature infants born after beginning of the study whose parents did not want to receive early intervention were included in the routine care group; all premature infants born after beginning of the study whose family intended to actively participate in early intervention were included in the intervention group. The numbers of infants in the two groups were quite close in each collaborative unit. In the intervention group, the premature infants received early intervention after discharge from hospital, in addition to routine care, once a month before corrected age of 6 months and once every two months after 6 months. The parents were instructed to cultivate the infant's cognition, language, emotion and communication ability, and the infants were given massage, subjected to exercise and received active motor training. All infants with abnormal motor manifestations were given appropriate rehabilitation training. In the routine care group, infants received similar routine care only.
RESULTS
In the 2 groups, no significant differences (P > 0.05) were found in complications of pregnant mothers, average gestational age and birth weight, proportion of small for gestational age (SGA), proportion of single and multiple births, fetal stress, postnatal asphyxia, incidence of neonatal hypoxic inschemic encephalopathy (HIE) and intracranial hemorrhage, Apgar Score and Neonatal Behavioral Neurological Assessment Score at 40 weeks of gestational age. These indicate that the two groups were comparable. At 1 year of age, the incidence of cerebral palsy was 0.91% (5/551) in the intervention group and 3.19% (16/502) in the routine care group (P < 0.01). Of the 5 cases with cerebral palsy in the interventional group, 3 were mild and 2 severe. Of the 16 cases in the routine care group, 7 were moderate and 9 severe.
CONCLUSION
Early intervention can reduce the incidence of cerebral palsy of premature infants. This conclusion awaits confirmation from studies with larger sample size.