摘 要
有新生兒期餵食困難的早產兒，將來有高風險會發生神經發展障礙。不同類型的神經發展障礙所需要的治療策略不同，而且及早介入效果較佳。因此若能預測有餵食困難的早產兒將來較易發生的神經發展障礙類型，將有助於制定追蹤治療策略。本研究探討新生兒期餵食困難對早產兒兩歲時的認知、語言和動作發展預後的影響。我們回顧了在2011年至2018年出生、胎齡<, 'Times New Roman';">週、出生後即住入奇美醫院新生兒加護病房早產兒的病歷，並排除有腦部病變的個案。有餵食困難的早產兒為病例組，而沒有餵食困難的早產兒為對照組，並依照胎齡、出生體重、性別和出生年份與病例組配對。我們記錄兩組在住院期間的基本資料及疾病，以及在兩歲追蹤時的貝氏嬰幼兒發展測驗評估結果。我們一共納入102名早產兒，病例組有34名，對照組有68名。與對照組相比，病例組有支氣管肺發育不良的發生率較高（61.8% vs. 33.8%），住院時間也更長（94.2 天 vs. 73.8 天）。在兩歲時，病例組的平均發展分數低於對照組，也有較高的比率發生認知（25.0% vs. 6.0%）、語言（28.1% vs. 13.4%）和動作（21.9% vs. 6.0%）發展遲緩。經校正其他可能會影響神經發展預後的因子後，新生兒期餵食困難對兩歲時發生認知發展遲緩有顯著影響。我們得到的結論是，有新生兒期餵食困難的早產兒在兩歲時出現神經發展障礙的風險很高，尤其是認知發展遲緩。針對此高風險的發展障礙類型早期制定介入策略，將有助於改善有餵食困難早產兒的神經發展預後。
關鍵詞：餵食困難、神經發展預後、早產兒
Abstract
Preterm infants with neonatal feeding difficulties are at high risk of neurodevelopmental disabilities. Early predicting the major type of disability is critical for timely intervention strategies and follow-up programs. This retrospective study investigated the impact of neonatal feeding difficulties on cognitive, language and motor outcomes in preterm infants at age 2 years. The medical records of preterm infants born at gestational age < 34 weeks between 2011 and 2018 and admitted to a medical center after birth were reviewed, and infants with brain lesions were excluded. Infants with feeding difficulties were identified as the case group, while infants without feeding difficulties in the control group were matched with gestational age, birth weight, sex, and birth year. The neurodevelopmental outcomes at age 2 years were assessed with the Bayley Scales of Infant Development-III. A total of 102 infants were enrolled, including 34 case and 68 control infants. Compared to the control infants, the case infants had significantly higher rates of bronchopulmonary dysplasia (61.8% vs. 33.8%) and longer duration of hospital stay (94.2 vs. 73.8 days). At age 2 years, the case group had lower mean developmental scores than the control group, with higher rates of delay in cognitive (25.0% vs. 6.0%), language (28.1% vs. 13.4%) and motor (21.9% vs. 6.0%) development. After adjusting for confounders, neonatal feeding difficulties significantly contributed to cognitive delay at age 2 years. In conclusion, preterm infants with neonatal feeding difficulties are at high risk of neurodevelopmental impairment at age 2 years, particularly cognitive delay. Early intervention targeted at the specific deficit may help improve neurodevelopmental outcomes in preterm infants.
Keywords: Feeding difficulties, Neurodevelopmental outcomes, Preterm infants