摘要
目的描述0~2岁儿童神经心理发育特征,分析出生体重与儿童神经心理发育之间的关联。方法采集2018年7月-2024年7月在浏阳市妇幼保健院接受健康体检的0~2岁儿童Gesell发育诊断量表测评记录以及相关出生与分娩信息。Gesell量表测评维度包括大运动、精细运动、适应性、语言、个人-社会5个能区及综合总评,测评结果以发育商(developmental quotient,DQ)表示,并按DQ由高到低分为正常、边缘状态、异常,异常又细分为轻度、中度、重度、极重度异常。采用广义估计方程与分位数回归模型调整潜在混杂因素,分析出生体重与儿童神经心理发育之间的关联。为排除同一儿童多次测评结果自相关性对神经心理发育特征及分位数回归结果的影响,针对测评多次儿童仅随机保留1次结果开展敏感性分析。结果研究纳入19027名儿童共29053次测评结果,神经心理发育总评正常17872人次(61.5%),边缘状态8691人次(29.9%),轻度异常2180人次(7.5%),中度异常228人次(0.8%),重度及极重度异常82人次(0.3%)。广义估计方程显示,同正常出生体重儿相比,低出生体重儿总评异常风险显著增加(OR=3.47,95%CI:2.98~4.04),5个能区异常风险均显著增加(OR范围:2.55~4.01);巨大儿是精细运动能区异常的保护因素(OR=0.69,95%CI:0.51~0.92),但与总评异常(OR=0.77,95%CI:0.55~1.07)及其他4个能区异常(OR范围:0.77~0.97)无显著关联。分位数回归显示出生体重与总DQ具有正向关联,出生体重对总DQ较低百分位数影响更大,出生体重每增加1 kg,总DQ第80百分位数增加1.7,而总DQ第20百分位数增加3.2;出生体重与5个能区DQ也有类似关联。敏感性分析与主分析结果基本一致。结论出生体重与0~2岁儿童神经心理发育具有正向关联,低出生体重是儿童神经心理发育异常危险因素,发育水平越低出生体重负性效应越强。
Objective To describe the characteristics of neuropsychological development of children aged 0-2 years and analyze the association between birth weight and neuropsychological development of children.Methods The study data were the assessment records of Gesell Developmental Schedule(GDS)and related birth and delivery information of children aged 0-2 years who received physical examination in Liuyang Maternal and Child Health Hospital from 2018 to 2024.The five dimensions of GDS include gross motor,fine motor,adaptability,language,personal-social behavior as well as a comprehensive assessment.The assessment results were expressed by developmental quotient(DQ),which were divided into normal,borderline and abnormal by DQ from high to low.The abnormal results were subdivided into mild,moderate,severe,and profound abnormalities.Generalized estimation equations(GEE)and quantile regression models were used to evaluate the association between birth weight and neuropsychological development of children after adjusting for potential confounders.In order to exclude the influence of autocorrelation of multiple assessment results about neuropsychological development characteristics of the same child,sensitivity analysis was conducted by randomly keeping only one of the results among children who received multiple assessments.Results A total of 29053 assessments from 19027 children were included in the study.The overall neuropsychological development was normal in 17872(61.5%),borderline in 8691(29.9%),mild abnormal in 2180(7.5%),moderate abnormal in 228(0.8%),and severe or profound abnormal in 82(0.3%)assessments,respectively.The GEE showed that compared with normal birth weight children,low birth weight children had a significant increase in the risk of overall abnormal neuropsychological development(OR=3.47,95%CI:2.98-4.04),and the risk of abnormal development was significantly increased in all 5 domains(OR range:2.55-4.01).Macrosomia was a protective factor for abnormal fine motor development(OR=0.69,95%CI:0.51-0.92),but not significantly associated with the overall abnormal development(OR=0.77,95%CI:0.55-1.07)or those of the other 4 domains(OR range:0.77-0.97).Quantile regression showed a positive association between birth weight and overall DQ,and birth weight had a greater effect on the lower percentile of overall DQ.With every 1 kg increase in birth weight,the 80th percentile of overall DQ increased by 1.7,while the 20th percentile of overall DQ increased by 3.2.There was also a similar association between birth weight and DQ of all 5 domains.The result of sensitivity analysis was basically consistent with that of the main analysis.Conclusion Birth weight is positively associated with neuropsychological development of children aged 0-2 years.Low birth weight is a risk factor for abnormal neuropsychological development,and the lower the development level the stronger the negative effect of low birth weight.
作者
丁滢方
刘扬
邓筱
周诗情
肖琳艳
李宏田
DING Yingfang;LIU Yang;DENG Xiao;ZHOU Shiqing;XIAO Linyan;LI Hongtian(Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health,Department of Epidemiology and Biostatistics,School of Public Health,Peking University,Beijing 100191,China)
出处
《中国生育健康杂志》
2026年第1期8-14,共7页
Chinese Journal of Reproductive Health
基金
国家重点研发计划(2023YFC2506800)。
关键词
神经心理发育
儿童
出生体重
Neuropsychological development
Children
Birth weight
