Influence factors of the neonatal behavioral neurological assessment in premature infant

Abstract

Objective To explore the application of neonatal behavioral neurological assessment (NBNA) in premature infant and the influence factors.Methods One handred and twenty-three premature neonates hospitalized in our neonatal department from January 2006 to June 2007 were enrolled in the study.The NBNA was carried out at corrected conceptus age 40w.The influence of conceptus age,birth weight,mechanical ventilation and the ventilation time,high risk factors of brain damage in perinatal period,different delivery methods,and the Apgar score on the outcome of NBNA were analyzed.Results There were significant differences of the NBNA results among the premature infants with different conceptus age (<30w,～32w,and ～34w) and birth weight (<1250g,～1500g,and ～2000g) (P<0.01).The NBNA score was lower as the neonate was younger with conceptus age and lower with birth weight.The NBNA scores in the neonates with ventilation and ventilation time more than 7d were obviously lower than that without ventilation (P<0.01)and ventilation time less than 7d (P<0.05).Furthermore the NBNA scores were markedly lower when the neonates complicated with hemorrhagic and ischemic brain damage,conjugated bilirubin ≥256.5μmol/L,hypoglycemia (<2.6μmol/L) and infection(P<0.01).And the NBNA in neonates with breech position,obstetrical forceps and vaccum extraction delivery was obviously lower than that in the cesarean delivery and spontaneous delivery (P<0.01).The neonate with Apgar score between 0 and 3 has lower NBNA in compared with those with Apgar score 4-7 and ≥8 (P<0.01).Conclusion There are many factors affecting on the NBNA outcome,such as conceptus age,birth weigh,ventilation and ventilation time,abnormal delivery methods,and severe asphyxia.In order to find intracalvarium pathological changes and give early intervention,decrease additional damage and sequelae,the skull ultrasound should be carried out at 3 to 7d after birth for the premature neonate,especially those whose conceptus age less than 32w and birth weight no more than 1500g or with high risk factors of brain damage. Key words: Infant,premature; Neonatal behavioral neurological assessment; Brain damage