極低出生體重早產兒的發展與神經預後之探討

The exploration of development and neurological prognosis in Very Low Birth Weight premature infants

羅麗君(Li Jiun Luo)

指導教授 ： 張李淑女

亞洲大學/健康學院/長期照護研究所在職專班/碩士(2009年)

摘要

本研究主要以長期追蹤研究法探討出生體重小於1500克之早產兒在不同矯正年齡時期的心智及動作發展是否出現遲緩，並探討個案及產婦之個人特質是否與其發展遲緩或持續性遲緩有相關性。研究期間共收案658人，並在不同矯正年齡進行心智及動作發展指數的評估，再以卡方獨立性檢定及列聯係數分析、獨立樣本T檢定、皮爾森積差相關分析、羅吉斯迴歸等方法進行推論統計。結果顯示，出生體重小於1000克之極度低出生體重兒出現嚴重併發症的機率高過出生體重1001-1500克之極低出生體重兒(相對風險為1.05)；在個人特質方面，不同矯正年齡之MDI及PDI遲緩的共同正相關因子為早產兒的出生週數及出生體重，共同負相關因子為住院平均天數，而產婦教育程度為不同矯正年齡之MDI遲緩的單獨相關因子；在嚴重併發症方面，造成矯正年齡24個月的MDI及PDI遲緩的共同危險因子為周邊腦室白質軟化症、嚴重腦室內出血、嚴重視網膜病變，而個別的危險因子在MDI方面為慢性肺部疾病，PDI方面則是新生兒敗血症及開放性動脈導管；在矯正年齡12-24個月之持續性遲緩方面，MDI及PDI之共同危險因子為出生體重小於1000克(極度低出生體重兒)、較長的住院平均天數、早期出現遲緩者(矯正年齡6個月)。本研究發現出生體重小於1500克之早產兒的發展遲緩存在一些個人特質及嚴重併發症的相關危險因子，而更詳盡的因果探討則需後續研究來解答。

關鍵字

極低出生體重兒 ； 心智發展指數 ； 動作發展指數

並列摘要

This article was based on the long term follow-up study to explore the delay developments (MDI & PDI) of very low birth weight infants (VLBWs, birth weight <1500g) in different followed corrected age. Of all, there were 658 samples enrolled in the studying period (Jan, 2001 to Dec, 2006), and rendered various characteristics and variables to be analyzed and described (by chi-squared test, independent sample t test, person correlation analysis, and logistical regression). The results as followed, the probability of serious complications in the group of extremely low birth weight infants (EVBWs) is higher than the VLBWs’ (related risk is 1.05); the lower birth weight and gestation age are two positive correlated co-factor in both of delay MDI and PDI, and the negative co-factor is longer stay of in-hospital. Otherwise, the lower educational degree of cases’ mother is an independent factor in poor MDI. In order to the relationship of serious complications and the delay MDI and PDI development of these cases, the co-factors in theperiod of 24-month corrected age are PVL, severe IVH and ROP; CLD for the delay MDI, and sepsis & PDA for the delay PDI are the individual factors, respectively; in the part of continuous delay conditions in MDI, or PDI, or both in the period of 12 to 24-month of corrected age, the co-factors are the group of extremely low birth weight (ELBWs), longer stay of in-hospital, and early delay in first 6-month of corrected age. Our findings demonstrate that the personal characteristics and the serious complications are the factors for delay developmental prognosis in the population of infants (birth weight <1500g), and the detail analysis based on further researches indeed.

並列關鍵字

Very low birth weight infants (VLBWs) ； Mental Development Index (MDI) ； Psychomotor Development Index (PDI)

參考文獻

Chen P. C., Doyle P. E., Pai L., & Wang J. D. (1999). Parental Socioeconomic Status and Low Birthweight, Preterm Delivery, and Small for Gestational Age in Taiwan. Chinese Journal of Public Health, 18(2), 105-115.

吳盈瑾（2008）．足月兒與極低出生體重早產兒於足月時之腦部血流參數與神經發展預後．未發表的碩士論文，台北：臺灣大學物理治療學研究所。

吳瑋琳（2007）．早產及低出生體重新生兒之危險因素分析：單、雙、多胞胎之影響．未發表的碩士論文，台北：臺灣大學衛生政策與管理研究所。

潘懿真、謝功毅、陳保中（1999）．早產兒危險因子之探討－社區性病例對照研究．中華公共衛生雜誌，18（6），460-465。

傅瓊瑤、陸振翮、吳欣玫、王銘賢、陳淑貞（1999）．青少女懷孕發生低出生體重與早產的危險性探討．中華衛誌，18，228-234。