Abstract:

Objective　By establishing the standardized follow-up monitoring mechanism for high-risk infants, the influence on the growth and development of high-risk infants was analyzed, and the basis for formulating reasonable nutrition support and early intervention strategies was provided. Methods　From January 2021 to January 2023, 260 high-risk infants were hospitalized in Binzhou Central Hospital. According to whether the high-risk infants returned to hospital regularly for follow-up, they were divided into a standardized follow-up group and a non-standardized follow-up group. In the standardized follow-up group, there were 170 high-risk infants, 78 boys and 92 girls, aged 12 (7,14) days, 112 cases with 1 high-risk factor and 58 cases with 2 high-risk factors. In the non-standardized follow-up group, there were 90 high-risk infants, 41 boys and 49 girls, aged 13 (7,15) days, 59 cases with 1 high-risk factor and 31 cases with 2 high-risk factors. The standardized follow-up group referred to regular return to the hospital after discharge according to the discharge follow-up schedule, and timely assessment and intervention measures were given according to the results of various examinations. In the non-standardized follow-up group, the infants did not return to the hospital regularly after discharge for follow-up and the number of lost visits was >3 times, but there were developmental assessment data at 4 time points of 2 weeks, 3 months, 6 months, and 12 months old. The physical development of high-risk infants at 6 months and 12 months old were compared between the two groups. The Neonatal Behavioral Neurological Assessment (NBNA) scores at 2 weeks and 4 weeks old were compared between the two groups. The Gesell development scale of 3-month old and 12-month old of high-risk infants were compared. The incidences of complications were compared between the two groups. t test, χ² test, and U test were used. Results　The body length, body weight, and head circumference of the high-risk infants in the standardized follow-up group were (70.4±7.8) cm, (8.7±1.6) kg, and (43.4±1.5) cm at 6 months old, and (78.3±6.4) cm, (11.4±1.5) kg, and (45.3±1.5) cm at 12 months old, respectively, which were higher than (62.8±8.7) cm, (7.6±2.3) kg, (41.4±1.1) cm, (76.6±7.6) cm, (10.7±1.9) kg, and (44.8±1.6) cm in the non-standardized follow-up group, with statistically significant differences (t=7.178, P<0.001; t=4.509, P<0.001; t=12.830, P<0.001; t=1.907, P=0.058; t=3.256, P=0.001; t=2.498, P=0.013). The NBNA scores of the high-risk infants in the standardized follow-up group were (36.67±2.18) and (38.59±1.61) points at 2 weeks and 4 weeks old, respectively, and those in the non-standardized follow-up group were (36.62±2.21) and (37.73±1.34) points, respectively. The NBNA scores of the two groups at 4 weeks old were higher than those at 2 weeks old, and the NBNA score of the standardized follow-up group at 4 weeks old was higher than that of the non-standardized follow-up group, with statistically significant differences (all P<0.05). At 3 months old, there were no statistically significant differences in the developmental retardation rates of gross motor, fine motor, adaptive behavior, language, or personal social between the two groups (all P>0.05). At 12 months old, the developmental retardation rates of the high-risk infants in both groups were significantly decreased, and the retardation rates of the high-risk infants in the non-standardized follow-up group were higher than those in the standardized follow-up group, with statistically significant differences (all P<0.05). The overall incidence of malnutrition and anemia in the standardized follow-up group was lower than that in the non-standardized follow-up group [5.8% (10/170) vs. 25.4% (23/90)], with a statistically significant difference (χ²=20.553, P<0.001). Conclusion　The establishment of standardized follow-up monitoring mechanism, sequential management of the growth and development of high-risk infants, and timely early intervention can promote their physical and neuropsychological development, which has important clinical significance in the growth and development of high-risk infants.

Key words:

High-risk infants, Follow-up, Standard, Physical development, Neuropsychological development

摘要：

目的　通过建立高危儿规范随访监控机制，分析对高危儿生长发育的影响，为制定合理的营养支持和早期干预策略提供依据。方法　选取2021年1月至2023年1月滨州市中心医院收治住院的高危儿260例，依据高危儿是否定期返院进行随访分为规范随访组和非规范随访组。规范随访组170例高危儿中男78例，女92例，日龄12（7，14）d，高危因素1项112例、2项58例；非规范随访组90例高危儿中男41例，女49例，日龄13（7，15）d，高危因素1项59例、2项31例。规范随访组是指根据出院随访计划表在出院后定期返院随访，并根据返院的各项检查结果，及时评估并给予干预措施；非规范随访组为出院后未规律返院随访且失访次数>3次，但有2周龄、3月龄、6月龄、12月龄4个时间点的发育评估资料。比较两组高危儿6月龄、12月龄的体格发育情况，2周龄、4周龄时的新生儿神经行为测定（NBNA）评分，3月龄、1月龄的Gesell发育量表评估情况及并发症发生情况。采用t检验、χ²检验、U检验。结果　规范随访组高危儿6月龄的身长、体质量和头围分别为（70.4±7.8）cm、（8.7±1.6）kg、（43.4±1.5）cm，12月龄分别为（78.3±6.4）cm、（11.4±1.5）kg、（45.3±1.5）cm，均高于非规范随访组的（62.8±8.7）cm、（7.6±2.3）kg、（41.4±1.1）cm、（76.6±7.6）cm、（10.7±1.9）kg、（44.8±1.6）cm，差异均有统计学意义（t=7.178、P<0.001，t=4.509、P<0.001，t=12.830、P<0.001，t=1.907、P=0.058，t=3.256、P=0.001，t=2.498、P=0.013）。规范随访组高危儿出生2周、4周时NBNA评分分别为（36.67±2.18）分、（38.59±1.61）分，非规范随访组分别为（36.62±2.21）分、（37.73±1.34）分，两组出生4周时NBNA评分均比出生2周时升高，且规范随访组高于非规范随访组，差异均有统计学意义（均P<0.05）。3月龄时，两组高危儿的大运动、精细动作、适应性行为、语言、个人社交发育迟缓率比较，差异均无统计学意义（均P>0.05）；12月龄时，两组高危儿的智能发育迟缓率均明显降低，且非规范随访组高危儿的智能发育迟缓率均高于规范随访组，差异均有统计学意义（均P<0.05）。规范随访组高危儿营养不良、贫血的总发生率低于非规范随访组［5.8%（10/170）比25.4%（23/90）］，差异有统计学意义（χ²=20.553，P<0.001）。结论　建立规范的随访监控机制，连续性管理高危儿的生长发育，可及时发现偏离并给予早期干预，可促进高危儿的体格发育及神经心理行为发育，在高危儿生长发育过程中有重要临床意义。

关键词:

高危儿, 随访, 规范, 体格发育, 神经心理发育