目的探讨全身运动(GMs)质量评估预测足月窒息新生儿24月龄时不良结局的价值。方法2009~2012年入住NICU、且出院后获得随访的114例足月窒息患儿为研究对象。生后3个月内进行GMs质量评估。出院后随访至24月龄时采用贝利婴幼儿发展量表(BSID)测试发育商。结果 GMs评估结果:扭动运动阶段为单调性全身运动的有20例(17.5%),为痉挛性同步运动的有7例(6.1%);不安运动阶段评估为不安运动缺乏的有8例(7.0%)。24月龄时发育商评估结果:有不良发育学结局共7例(6.1%),其中脑瘫伴智力发育迟滞6例,智力发育迟滞1例。GMs评估示扭动运动阶段单调性全身运动与24月龄时患儿发育结局的一致性差(Kappa=-0.019, P>0.05)。痉挛性同步运动与24月龄时患儿发育结局的一致性较高(Kappa=0.848,P<0.05),其对24月龄发育结局的预测效度为98.2%,敏感度为85.7%,特异度为99.1%,阳性预测值为85.7%,阴性预测值为99.1%。不安运动阶段不安运动缺乏与24月龄时患儿发育结局的一致性较高(Kappa=0.786,P<0.05),其对24月龄发育结局的预测效度为97.4%,敏感度为85.7%,特异度为98.1%,阳性预测值为75.0%,阴性预测值为99.1%。结论 GMs评估示痉挛性同步运动和不安运动缺乏对窒息新生儿24月龄时的不良发育结局有较好的预测价值。
Abstract
Objective To investigate the predictive value of the qualitative assessment of general movements (GMs) for adverse outcomes at 24 months of age in full-term infants with asphyxia. Methods A total of 114 fullterm asphyxiated infants, who were admitted to the neonatal intensive care unit between 2009 and 2012 and took part in follow-ups after discharge were included in the study. All of them received the qualitative assessment of GMs within 3 months after birth. The development quotient was determined with the Bayley Scales of Infant Development at 24 months of age. Results The results of the qualitative assessment of GMs within 3 months after birth showed that among 114 infants, 20(17.5%) had poor repertoire movements and 7(6.1%) had cramped-synchronized movements during the writhing movements period; 8 infants (7.0%) had the absence of fidgety movements during the fidgety movements period. The results of development quotient at 24 months of age showed that 7 infants (6.1%) had adverse developmental outcomes:6 cases of cerebral palsy and mental retardation and 1 case of mental retardation. There was a poor consistency between poor repertoire movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=-0.019; P>0.05). There was a high consistency between cramped-synchronized movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=0.848; P<0.05), and the results of predictive values of cramped-synchronized movements were shown as follows:predictive validity 98.2%, sensitivity 85.7%, specificity 99.1%, positive predictive value 85.7%, and negative predictive value 99.1%. There was a high consistency between the absence of fidgety movements during the fidgety movements period and the developmental outcomes at 24 months of age (Kappa=0.786; P<0.05), and its predictive values were expressed as follows:predictive validity 97.4%, sensitivity 85.7%, specificity 98.1%, positive predictive value 75.0%, and negative predictive value 99.1%. Conclusions Cramped-synchronized movements and absence of fidgety movements can predict adverse developmental outcomes at 24 months of age in full-term infants with asphyxia.
关键词
窒息 /
发育商 /
全身运动质量评估 /
贝利婴幼儿发展量表 /
婴儿
Key words
Asphyxia /
Development quotient /
Qualitative assessment of general movements /
Bayley Scales of Infant Development /
Infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Azzopardi D, Strohm B, Marlow N, et al. Effects of hypothermia for perinatal asphyxia on childhood outcomes[J]. N Engl J Med, 2014, 371(2):140-149.
[2] Philippi H, Karch D, Kang KS, et al. Computer-based analysis of general movements reveals stereotypies predicting cerebral palsy[J]. Dev Med Child Neurol, 2014, 56(10):960-967.
[3] Prechtl HF, Einspieler C, Cioni G, et al. An early marker for neurological deficits after perinatal brain lesions[J]. Lancet, 1997, 349(9062):1361-1363.
[4] 易受蓉, 罗学荣, 杨志伟, 等. 贝利婴幼儿发展量表在我国的修订(城市版)[J]. 中国临床心理学杂志, 1993, 1(2):71-75.
[5] 《中华儿科杂志》编辑委员会, 中华医学会儿科学分会神经学组. 小儿脑性瘫痪的定义、诊断条件及分型[J]. 中华儿科杂志, 2005, 43(4):262.
[6] 马良, 孟令丹, 郑春辉, 等. 影响婴儿全身运动质量的高危因素[J]. 中国当代儿科杂志, 2014, 16(9):887-891.
[7] 苏允鹏, 杨红, 史惟, 等. 全身运动质量评估对足月脑损伤儿脑瘫发育结局的预测价值[J]. 中国儿童保健杂志, 2014, 22(7):680-682.
[8] Yang H, Einspieler C, Shi W, et al. Cerebral palsy in children: movements and postures during early infancy, dependent on preterm vs. full term birth[J]. Early Hum Dev, 2012, 88(10): 837-843.
[9] Batstra L, Neeleman J, Hadders-Algra M. The neurology of 1earning and behavioural problems in pre-adolescent children[J]. Acta Psychiatr Scand, 2003, 108(2):92-100.
[10] Ferrari F, Todeschini A, Guidotti I, et al. General movements in full-term infants with perinatal asphyxia are related to Basal Ganglia and thalamic lesions[J]. J Pediatr, 2011, 158(6):904-911.
[11] Aylward GP. Neurodevelopmental outcomes of infants born prematurely[J]. J Dev Behav Pediatr, 2005, 26(6):427-440.
[12] 史明靖, 温晓红, 黄金华, 等. 全身运动质量评估对高危儿神经发育结局的预测效度研究[J]. 中国妇幼保健, 2011, 26(36): 5714-5717.
[13] 杨红, 史惟, 邵肖梅, 等. 全身运动质量评估对高危新生儿神经学发育结局信度和预测效度的研究[J]. 中国循证儿科杂志, 2007, 2(3):172-180.
[14] Groen SE, de Bléocurt AC, Postema K, et al. General movements in early infancy predict neuromotor development at 9 to 12 years of age[J]. Dev Med Child Neurol, 2005, 47(11): 731-738.
[15] Nakajima Y, Einspieler C, Marschik PB, et al. Does a detailed assessment of poor repertoire general movements help to identify those infants who will develop normally?[J]. Early Hum Dev, 2006, 82(1):53-59.
[16] Hadders-Algra M. General movements:A window for early identification of children at high risk for developmental disorders[J]. J Pediatr, 2004, 145(2 Suppl):S12-S18.
[17] Mutlu A, Livanelio?lu A, Korkmaz A. Assessment of ""general movements"" in high-risk infants by Prechtl analysis during early intervention period in the first year of life[J]. Turk J Pediatr, 2010, 52(6):630-637.
基金
安徽高校省级自然科学研究项目(KJ2012Z171);合肥市科技局自主创新社会发展类专项资助项目(2013-25-9)。
PDF(1286 KB)
