| Background Neonatal hypoglycemia is the most common metabolic disease in the neonatal period.Repeated or severe hypoglycemia can lead to brain damage and even cause a series of neurodevelopmental.At present,the relationship between the level of blood glucose and brain damage is unclear.The follow-up study on the long term neurodevelopmental outcome after neonatal hypoglycemia is relatively rare.Objective Our purpose is to investigate neurodevelopmental outcomes in the preschool children who ever was diagnosed neonatal hypoglycemia in the Neonatology Department of Anhui Provincial Childeren's Hospital,including intelligence development,social life ability,psychological behavior development and temperament development.In order to make sure the effect of family environment,we also analyzed the correlation between the family environment characteristics and neurodevelopmental outcomes.Method 40 patients diagnosed as neonatal hypoglycemia was chosed as hypoglycemia group between January 2009 and December 2012 in the Neonatology Department of Anhui Provincial Childeren's Hospital.According to the clinical manifestations and head MRI findings,the patients in hypoglycemia group were divided into brain injury group including 20 cases and non-brain injury group including 20 cases.At the same time,38 healthy children with similar gestational age were selected as control group during the same time.Firstly,we analyzed the statistic differences in neurodevelopmental outcome between the hypoglycemia group and the control group during preschool period,including intelligence development especially in total intelligence,speech comprehension,visual space,and working memory;social life ability;mental and behavioral development especially in behavior,learning,anxiety,hyperactivity,and temperament development.Secondly,we analyzed the correlation between intelligence development,social life ability,psychological behavior problems,temperament development and family environment characteristics in hypoglycemia group.Thirdly,we analyzed the correlation during mental development,psychological behavior and temperament development in hypoglycemia group.Fourthly,the statistic difference of neurodevelopmental outcome was compared during brain injury group,non-brain injury group and control group.Fifthly,we analyzed the correlation during intelligence development,social life ability,psychological behavior,temperament development and family environment characteristics in hypoglycemic brain injury group.Sixthly,we analyzed the correlation during mental development,mental behavior problems and temperament development in hypoglycemic brain injury group.Result 1 Comparison of follow-up results of neurodevelopmental outcomes between the hypoglycemia group and the control group 1.1 The total IQ score in the hypoglycemia group was lower than that in the control group,and the difference was statistically significant(t=4.353,P<0.05).The verbal comprehension,visuospatial and working memory scores in the mental development structure were lower than those in the control group,and the difference was statistically significant(P<0.05).1.2 The score of social life ability in the hypoglycemia group was lower than that in the control group,and the difference was statistically significant(t=3.218,P<0.05).1.3 The scores of behavior and learning problems in the development of psychological behavior in the hypoglycemia group were higher than those in the control group.The difference was statistically significant(P<0.05).1.4 The scores of phobotaxis,adherence in temperament development in the hypoglycemia group is significantly higher than the control group.The difference was statistically significant(P<0.05).The response threshold score in the hypoglycemia group was lower than that in the control group,and the difference was statistically significant(t=2.088,P<0.05).2 Correlation between neurodevelopmental outcome and family environment characteristics in the hypoglycemia group 2.1 The total IQ of the hypoglycemia group is positively related to the success(r=0.438),knowledge(r=0.464)and recreation(r=0.351)of the family(P<0.05).Verbal comprehension are positively correlated with family success(r=0.430)and knowledge(r=0.463,P<0.05).Visual spatial scores are negatively with family ambivalence(r=-0.404,P<0.05).Visual spatial scores are positively correlated with success(r=0.434,P<0.05).The scores of working memory are positively correlated with family success,knowledge and recreation(P<0.05).2.2 The scores of social life ability are negatively correlated with family independence in hypoglycemia group(r=-373,P<0.05),but are positively correlated with knowledge(r=0.340,P<0.05).2.3 Behavior problems,impulsivity hyperactivity problems and hyperactivity index are negatively correlated with family moral values in hypoglycemia group(P<0.05).The learning problem is negatively correlated with the organization of family(r=-0.443,P<0.05).2.4 There is a negative correlation between activity level and family morality in temperament development(r=0.348,P<0.05).Rhythm is positively correlated with family knowledge and recreation(P<0.05).Adaptability and persistence are negatively correlated with success and knowledge of family(P<0.05).The intensity of reaction is positively correlated with the cohesion and organization of family(P<0.05).Attention dispersion is negatively correlated with family cohesion(r=-0.441,P<0.05).Attention dispersion is positively correlated with contradiction(r=0.432,P<0.05).The threshold of response is positively related to family organization(r=0.330,P<0.05).3 Correlation during mental development,social life ability,psychological behavior problems and temperament dimension in hypoglycemia group 3.1 The scores in total IQ,verbal comprehension and working memory scores are negatively correlated with aversion and adaptability of temperament development in hypoglycemia group(P<0.05).The scores of visual space are negatively correlated with activity,aversion and adaptability of temperament development(P<0.05).The scores of visual space are positively correlated with rhythmicity in hypoglycemia group(r=0.454,P<0.05).3.2 The social life ability is negatively correlated with phobotaxis,persistence of temperament development(P<0.05).3.3 Behavior problems,learning problems and hyperactivity index are positively correlated with the level of activity in temperament development(P<0.05).The anxiety is positively correlated with the phobotaxis(r=0.490,P<0.05).Psychosomatic problems,impulsivity and hyperactivity are negatively correlated with the intensity of reaction(P<0.05).Behavior problems,learning problems,impulsivity hyperactivity and hyperactivity index were negatively correlated with the response threshold(P<0.05).4 Comparison of the follow-up outcomes during hypoglycemic brain injury group,hypoglycemia non-brain injury group and control group 4.1 The total IQ scores during the three groups were statistically significant(F=10.620,P<0.05).The total intelligence quotient of brain injury group is lower than that non-brain injury group and control group.4.2 In the mental development structure,there are significant differences in speech comprehension ability(F=8.958,P<0.05),visuospatial ability(F=16.675,P<0.05)and working memory(F=4.994,P<0.05)during the three groups.In visual space,the scores of brain injury group are lower than those in non-brain injury group and control group,and the difference is statistically significant.However,there are no significant differences in speech comprehension ability and working memory between the brain injury group and the non-brain injury group,but these are statistically significant compared with the control group.4.3 There are significant differences in the scores of social life ability during the three groups(F=5.212,P<0.05).The scores of brain injury group and non-brain injury group are lower than that of the control group(P<0.05).But there is no significant difference in the scores between the brain injury group and the non-brain injury group(P<0.05).4.4 The scores of psychological and behavioral development in the three groups are not statistically significant(P<0.05).4.5 The three groups in the evaluation of phobotaxis,adherence scores in temperament development showed significant differences(P<0.05).The scores of brain injury group in phobotaxis,adherence are higher than those in the non-brain injury group and control group.There are no statistical differences in he scores of other factors.Correlation between neurodevelopmental outcome and family environment characteristics in hypoglycemic brain injury group 5.1 The total intelligence,speech comprehension and working memory are positively correlated with fanmily success and knowledge in hypoglycemic brain injury group(P<0.05).Speech comprehension is negatively correlated with family independence(r=-0.344,P<0.05).Visual space and working memory are positively correlated with family entertainment(P<0.05).5.2 There is no correlation between social life ability and family environment characteristics in the hypoglycemic brain injury group.5.3 Behavior problems are negatively correlated with family morality in hypoglycemic brain injury group(r=-0.683,P<0.05).Psychosomatic problems are positively correlated with family success(r=0.541,P<0.05).Hyperactivity index is positively correlated with family contradiction(r=0.541,P<0.05).6 Correlation of intelligence development,social life ability and psychological behavior problems with temperament dimensions 6.1 The total intelligence,verbal comprehension and working memory are negatively correlated with phobotaxis of temperament development(P<0.05).Speech comprehension and working memory are negatively correlated with adaptability(P<0.05).There is no correlation between visual spatial and temperament dimensions.6.2 There is no correlation between social life ability and temperament development dimension in the hypoglycemic brain injury group.6.3 Behavior problems,learning problems and hyperactivity index were negatively correlated with the response threshold(P<0.05).Behavior problems are positively correlated with reaction intensity(r=0.587,P<0.05).Psychosomatic problems are negatively correlated with adaptability(r=-0.557,P<0.05).Phobotaxis is positively correlated with anxiety(r=0.551,P<0.05).Conclusion 1 The children with neonatal hypoglycemic brain damage have different levels of intelligence development,social life ability,psychological behavior and temperament development in preschool period.2 The lower family desire for knowledge and success is low and have less recreational activities,it affects the development of intelligence and temperament in children with hypoglycemic brain injury.Incorrect moral attitude could increase mental and behavioral problems in children.3 The children with neonatal hypoglycemia brain damage are characterized by low introversion and adaptability,and their intelligence development is low,their response threshold is low and activity level is high.The possibility of happenning psychological and behavioral problems is increases. |
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