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目的 探讨极低/超低出生体重早产儿生后早期及校正胎龄足月时头颅超声检查结果与神经发育预后的关系.方法 回顾性分析2012年1月至2016年12月生后24 h内入住北京大学第一医院新生儿重症监护病房、出生体重＜1 500 g且存活出院并规律随访早产儿的临床及辅助检查资料.早期头颅超声的检查时限为生后0～14d,观察指标为脑室周围-脑室内出血(periventricular-intraventricular haemorrhage,PVH-IVH)(分为无、Ⅰ °、Ⅱ°、Ⅲ°、Ⅳ°)和脑室旁白质回声(分为正常、轻度增强/轻度病变、显著增强/病变).校正胎龄足月头颅超声的检查时限为校正胎龄37～44周,观察指标为脑室旁白质软化(periventricular leukomalacia,PVL)和脑室增宽.神经发育以随访期Gesell发育诊断量表评估.应用SPSS 16.0完成统计学分析.结果 共有200例早产儿符合入选标准,胎龄(30.1±1.9)周,出生体重(1 203±186)g.住院期间完成头颅超声检查的中位数是3次,完善Gesell发育筛查的月龄为(11.8±4.0)月,校正月龄为(9.7±4.0)月,大运动能区发育商低于适应性、精细运动、语言和个人社交四个能区,差异均有统计学意义(P＜0.05).生后早期头颅超声提示PVH-IVHⅢ°/Ⅳ°、脑室旁白质病变,校正足月头颅超声提示PVL、脑室增宽均与大运动落后相关(P＜0.05),其中PVL与五个能区发育商低均相关(P＜0.05).结论 极低/超低出生体重早产儿以大运动落后最为突出.生后早期头颅超声提示Ⅲ°/Ⅳ° PVH-IVH、脑室旁白质病变,校正足月头颅超声提示PVL、脑室增宽均为校正中位年龄9.7个月大运动落后的危险因素.其中,校正足月头颅超声提示PVL者神经发育全面预后不良.“,”Objective To study the role of sequential cranial ultrasound (cUS) in the early prognosis of neurodevelopmental outcome in the very low birth weight and extremely low birth weight preterm infants.Method Clinical and examination data of premature infants with birth weight less than 1 500 g,who were admitted to the neonatal intensive care unit of our hospital within 24 hours after birth from January 2012 to December 2016 were analyzed retrospectively.Early cranial ultrasound refers to the cUS scans during the period of 0 to 14 days after birth.Classification was applied to the whole set of early cUS scans based on the most severe lesion observed.Index 1 was periventricular-intraventricular hemorrhage (PVH-IVH),which was divided into none and grade 1 to 4 according to the severity.Index 2 was paraventricular white matter echo,which was divided into normal,slightly enhanced and significantly enhanced.The cUS scan repeated at term-equivalent age (corrected gestational age 37 ～ 44 weeks) was referred to as term cUS.Term cUS was evaluated according to paraventricular leukomalacia (PVL) and enlargement of ventricle.Data were analyzed using IBM SPSS Statistics version 16.0.Result A total of 200 premature infants were collected.The gestational age was (30.1 ± 1.9) weeks,and the birth weight was (1 203 ± 186) g.The median time of cUS scans during hospitalization was 3 times.The age at which the Gesell Development Diagnosis Scale was completed was (11.8 ±4.0) months,the corrected age was (9.7 ±4.0) months.The development quotient (DQ) of gross motor was lower than that of the other four items,and the difference was statistically signi icant.Analysis of data suggested that PVH-IVH grade 3 or grade 4,significantly enhanced paraventricular white matter echo found in early cUS,and PVL or enlargement of ventricle found in term cUS were all associated to lower gross motor DQ (P ＜ 0.05).PVL was also significantly correlated with lower DQ of adaptability,fine motor,language and personal-social (P ＜ 0.05).Conclusion Compared to adaptability,fine motor,language and personal-social,gross motor has the lowest DQ among very low or extremely low birth weight infants.PVH-IVH grade 3 or worse,significantly enhanced paraventricular white matter echo found in early cUS,and PVL or enlargement of ventricle found in term cUS are high risk factors for adverse outcome of gross motor.Among them,PVL found in term cUS suggests poor neurodevelopmental outcome.