Retrospective Study Of The Perinatal Risk Factors On Neurodevelopmental Outcomes In Preterm Infants

BackgroundWith the development of modern perinatal medicine and neonatal care,the survival rate of preterm infants has been significantly increased.However,due to the immature brain and various potential risk factors that may impair the neurodevelopment in the perinatal period,preterm infants may leave a series of neurological sequelae,seriously affecting their long-term quality of life.While improving the survival rate of preterm infants,the public's expectation of medical prognosis is constantly increasing.How to reduce the rate of neurodevelopmental disability of preterm infants and achieve the effect of healthy rearing has become the focus of clinical and scientific research.Therefore,it is of great significance to study the neurodevelopmental outcomes and it's possible risk factors of neurodevelopmental abnormalities to guide the formulation and implementation of clinical early intervention measures,so as to further improve the neurodevelopmental prognosis of preterm infants.ObjectiveTo analyze the early neurodevelopment and perinatal risk factors of preterm infants with different gestational ages?GA?,and investigate the prognostic effect of neonatal complications on neurodevelopmental abnormalities,so as to provide prospective guidance for early clinical intervention.MethodsA total of 243 preterm infants born and hospitalized in Guangzhou Women and Children's Medical Center from January 2015 to December 2018,and followed up regularly for one year after discharge,were included in the retrospective study.Registration Form was designed to collect the clinical date and follow-up information of preterm infants with different GA,in order to compare their differences in basic information,perinatal factors and neurodevelopmental quotient.According to the?Neuropsychological Development scale for Children aged 0?6?,DQ<85 is defined as the standard to calculate the incidence of neurodevelopmental abnormalities in preterm infants,and to analyze the perinatal risk factors affecting their neurodevelopmental outcomes at 6 months and 12 months.Results1.A total of 243 preterm infants were included in the study,including 146 males?60.1%?and 97 females?39.9%?.GA from 25⁺⁴ to 36⁺⁶ weeks?32.7±2.7?,and birth weight from 770 to 3280g?1861±572g?.They are divided into three groups according to GA,the first group with GA less 32 weeks 89 cases?36.6%?,the second group with GA at32?33⁺66 weeks 56 cases?23.1%?,and the third group with GA at 34?36⁺66 weeks 98 cases?40.3%?.2.There was statistically significant on the adaptability,gross motor,fine motor,language,individual social development and DQ in preterm infants with different GA at the age of 6 months and 12 months?P<0.05?.At the same time,the neurodevelopmental quotient of preterm infants with GA less 32 weeks significantly behind that of two groups?P<0.05?.3.The differences in the incidence of neurodevelopmental abnormalities in preterm infants with different GA at 6 months and 12 months both were statistically significant?P<0.05?.Among them,the incidence was 49.3%,21.3%,29.4%at 6 months,and 52.3%,22.9%,24.8%at 12 months,respectively.4.SGA?OR=2.168,95%CI=1.087?4.332?and intrauterine distress?OR=3.442,95%CI=1.031?11.489?were the risk factors for neurodevelopmental abnormalities in preterm infants at 6 months.5.IVF/ICSI?OR=6.261,95%CI=1.565?25.043?was a risk factor for neurodevelopmental abnormalities at 12 months.However,GA?OR=0.790,95%CI=0.658?0.949?was a protective factor,and negatively correlated with the risk of neurodevelopmental abnormalities.6.Three complications with the highest risk were ROP?OR=7.923/3.328?,BPD?OR=7.056/2.556?and NRDS?OR=2.452/2.401?.Combining these complications will further increase the risk of neurodevelopmental abnormalities,the more the number,the greater the risk.One complication:OR=1.717/2.380,?=0.846/0.867,two complications:OR=8.864/3.495,?=2.182/1.251;three complications:OR=10.909/7.081,?=2.390/1.957.Conclusion1.Preterm infants with GA less 32 weeks are at high risk of neurodevelopmental abnormalities,and should be followed up for at least 1 year after discharge.In addition,late preterm infants also need close follow-up and early intervention.2.SGA,intrauterine distress and IVF/ICSI are the high risk factors for neurodevelopmental abnormality in preterm infants within 12 months years old,while GA is the protective factor,which is negatively correlated with neurodevelopmental abnormality,and the risk of neurodevelopmental abnormality decreases with the increase of GA.3.The combination of ROP,BPD,and NRDS further increased the risk of neurodevelopmental abnormalities in preterm infants at 6?12 months,and the more the number,the greater the risk.