日本未熟児新生児学会雑誌　第23巻　第1号　141～149頁（2011年）

日本未熟児新生児学会雑誌　23(1)：141-149；2011　

受付日：平成22．06．14

受理日：平成22．09．16

極低出生体重児の3歳時予後と集団保育参加の関係について

Is There Any Advantage of Group Nursing for the Neurodevelopmental Outcomes in VLBW Infants at 3 Years of Age ?

＊1愛育病院　小児科，＊2厚生労働科学研究「周産期母子医療センターネットワーク・フォローアップ班」，＊3日本こども家庭総合研究所，＊4愛育病院　新生児科，＊5大阪府立母子保健総合医療センター　臨床試験支援室，＊6自治医科大学　小児科

＊1 Department of Pediatrics, Aiiku hospital ＊2 The follow-up study group of NICU-Network in Japan, A Multicenter Benchmark Research on Neonatal Outcome in Japan ＊3 Japan Child and Family Research Institute ＊4 Department of Neonatology, Aiiku hospital ＊5 Clinical Trials Office, Osaka Medical Center and Research Institute for Maternal and Child Health ＊6 Department of Pediatrics, Jichi Medical University

石井のぞみ＊1＊2・佐藤紀子＊1＊2・安藤朗子＊3・加部一彦＊4・山口規容子＊1・米本直裕＊2＊5・河野由美＊2＊6

Nozomi ISHII＊1＊2，Noriko SATO＊1＊2，Akiko ANDO＊3，Kazuhiko KABE＊4， Kiyoko YAMAGUCHI＊1，Naohiro YONEMOTO＊2＊5，Yumi KONO＊2＊6

Key Words：VLBWI，follow up，development，Kyoto scale of psychological development，group nursing

　2003年出生の極低出生体重児（以下VLBWI）の周産期ネットワーク共通データベースを用い，3歳時予後と集団保育の関係について検討した。予後データが登録された1,701名中，「集団保育など」に回答のあった722名から，新版K式発達検査の発達指数（以下DQ）に入力があり，かつ12の背景項目全てに回答のあった427名を対象とした。背景比較では「集団保育あり」群が「なし」群に比べ，修正36週時の慢性肺疾患，未熟網膜症治療，脳性麻痺の合併が高率であった。背景因子を調整した重回帰分析では全領域DQ，認知適応領域DQ，言語社会領域DQと統計学的な有意差はあるが，関連の強さ（回帰係数）は2.3～4.1程度で，その臨床的な意義はさほど大きくはなく，「保育園」と「集団保育なし」での比較でも同様の結果であった。本解析は限定された対象ではあるが，VLBWIにおいて集団保育への参加がDQの上昇と関連している可能性があると考えられた。

Aim：The object of research was to investigate effects of group nursing as an intervention to improve the neurodevelopmental outcomes for very low birth weight infants（VLBWI）at 3 years of age.
Subjects and methods：Data for these analyses were derived from the Japanese Registry data base for VLBWI born in 2003. Among these infants, data of development test at 3 years of age were obtained from 1701 infants.
Results：Results of questionnaire in terms of the group nursing were obtained from 722 infants. The study subjects were consisted of 427 infants who were providing complete data for 12 background factors and full DQ and DQ of the three areas measured by Kyoto scale of psychological development test.
　Two hundred eight infants who have had group nursing tend to have histories of chronic lung disease, retinopathy of prematurity and cerebral palsy. They had a statistically significant positive relationship to the level of full DQ, cognitiveadaptive DQ and language-social DQ（regression coefficients were between 2.3 to 4.1）．Comparison between the factors of attendance of nursery school and no group nursing demonstrated similar results.
Conclusion：Because of the lack of the data and the small numbers of study subjects, degree of an advantage of group nursing as intervention for the neurodevelopment is still unclear, but it may be having some favorable effect on the development of VLBWI infants.