非脑瘫早产儿早期全身运动质量评估结果与神经认知发育情况的关联性研究

目的了解早期全身运动(GMs)评估结果为异常/可疑的非脑瘫早产儿与筛查正常的早产儿在婴幼儿期神经、认知等各方面整体发育水平的差异,以探索GMs评估与儿童轻微神经功能障碍的关系。方法选取2009-2017年在上海市闵行区妇幼保健院扭动阶段或不安阶段至少进行过1次GMs评估的早产儿,于矫正后9、12、24月龄评估其智力指数(MI)、发育商(DQ)。结果单因素分析显示,扭动阶段/不安阶段结果为异常/可疑的非脑瘫早产儿与正常结果相比,MI与DQ差异均无统计学意义(P>0.05);多因素分析显示,不安运动结果为异常/可疑与正常相比,发育异常结局的可能性大(9月龄:OR=3.075,95%CI:1.013～9.331;12月龄:OR=3.638,95%CI:1.552～8.527;24月龄:OR=2.750,95%CI:1.213～6.242);不安运动评估结果对不同年龄发育异常结局预测的灵敏度较低(8.82%～18.60%),特异度较高(>95%)。结论 GMs评估在预测婴幼儿后期神经、运动发育情况存在局限性,不可取代后续的各类发育评估与监测。

Study on the correlation between general movements assessment results and developmental outcome in preterm infants without cerebral palsy

Objective To analyze the difference on the overall developmental outcomes measured by Development Screening Test (DST) in children with abnormal and normal results of general movements (GMs), in order to explore the correlation between GMs assessment mild neurologic dysfunction. Methods Participants were recorded with GMs assessment results during writhing and fidgety movement period from 2009 to 2017.And the developmental quotient (DQ) and mental index (MI) were assessed by DST at 9,12 and 24 months old. Results Single factor analysis showed that there was no significant differences on DQ and MI results between children with normal and abnormal GMs assessment results among 9,12 and 24-month-old infants.After adjusting confounding factors, abnormal results of GMs fidgety movement indicated high risk of abnormal developmental outcomes(9 months old:OR=3.075,95%CI:1.013-9.331;12 months old:OR=3.638,95%CI:1.552-8.527;24 months old:OR=2.750,95%CI:1.213-6.242).The sensibility of GMs assessment to predict later outcome was low(8.82%~18.60%), while the specificity was high(＞95%). Conclusion GMs assessment has limitation to predict later development outcome of infants, and can not replace other development assessments.