婴儿原发性纵隔肿瘤58例临床分析

目的通过分析婴儿原发性纵隔肿瘤的发病特点、临床表现、疗效与并发症,探讨其诊治经验。方法回顾性分析2010年1月至2叭4年12月间本院经手术治疗的58例原发性纵隔肿瘤患儿临床资料,总结其临床表现、原发部位、手术及术后并发症。结果 58例中,男33例,女25例,最小年龄15天,最大年龄12个月(平均4.5个月)。原发肿瘤中,神经源性肿瘤占51.7%,生殖细胞瘤占24.1%,间叶组织肿瘤占20.7%。42例出现临床症状,其中气促26例,占46.5%,发热5例,占8.6%,咳嗽5例,占8.6%,呼吸窘迫3例,占5.2%。良性肿瘤24例(占41.4%),恶性肿瘤34例(占58.6%)。均予手术治疗,其中根治性切除手术53例,大部分切除术5例,仅1例予术后化疗。58例已随诊2个月至5年,无手术相关死亡,无一例复发,术后出现霍纳氏综合征2例,膈神经损伤1例。结论婴儿纵隔肿物的早期诊断较困难,需依赖临床症状和胸部CT检查。手术是治疗婴儿纵隔肿瘤安全有效的治疗方案。     

新生儿脑梗死58例分析

目的 分析近年来收治的58例新生儿脑梗死病例的临床资料及预后,为临床诊治提供可借鉴的经验.方法 对复旦大学附属儿科医院新生儿科1999年1月至2010年12月收治的58例新生儿脑梗死病例的临床资料及随访结果进行回顾性分析.结果 58例脑梗死患儿中52例为足月儿,6例为早产儿.缺血性梗死51例(占87.9％),出血性梗死7例(占12.1％).围产期缺氧缺血是最常见的高危因素(占46.6％).惊厥是新生儿脑梗死最常见的首发症状及病程中最多见的临床表现(占77.6％),其次为阵发性青紫、呼吸暂停及反应差.新生儿脑梗死最易累及大脑中动脉,且左侧多见.新生儿脑梗死急性期以支持和对症治疗为主.预后不良的患儿中,梗死多累及深部灰质核团或波及多个脑叶.结论 围产期缺氧是常见的高危因素.惊厥是最常见的早期临床表现.弥散加权成像技术对急性期脑梗死的诊断价值较高.不良预后的患儿中,梗死多累及深部灰质或范围较广.早期发现、结合头颅影像学检查作出诊断,对于指导康复治疗、改善预后有积极的意义.     

影响婴儿全身运动质量的高危因素

目的 婴儿全身运动（GMs）质量评估技术是预测婴儿脑功能异常的有价值的工具,该研究旨在探讨影响婴儿 GMs 质量的高危因素。方法 分别选取 618 例扭动运动阶段和 539 例不安运动阶段婴儿进行 GMs 评估。 采用单因素方差分析、卡方检验及多因素 logistic 回归分析调查影响婴儿 GMs 质量的高危因素。结果 扭动运动阶段,多因素 logistic 回归分析显示有统计学意义的影响因素为出生胎龄（OR=0.762,POR=0.264,POR=2.445,P=0.012）、宫内窘迫（OR=4.865,POR=0.786,P=0.003）、出生体重（OR=0.217,POR=3.765,P=0.001）、高胆红素血症（OR=2.640,P=0.028）。结论 出生胎龄、出生体重、重度窒息、宫内窘迫、高胆红素血症是异常 GMs 的高危因素,应早期筛查、干预。     

婴儿运动能力检查对早产儿运动发育异常的早期诊断价值文献回顾

目的　评估新生儿神经行为评分（neonatal behavioral neurological assessment,NBNA）与婴儿运动能力检查（the test of infant motor performance,TIMP）对早产儿运动发育异常的早期诊断价值。方法　检索Pubmed、Embase、Cochrane Library、万方、中国知网数据库,查询从建库至2017-05-20有关早产儿中使用NBNA或者TIMP进行神经行为或运动评估的文献,使用基于共识选择健康测量工具的标准清单（the consensus-based standards for selection of measurement instruments checklist,COSMIN）进行方法学质量评价,并分析NBNA与TIMP的预测效度。结果　最终获得16篇符合标准的文献,其中,5篇关于NBNA在早产儿随访中的应用研究,均存在明显威胁研究的方法学质量的因素;11篇关于TIMP在早产儿随访中的应用研究,其中9篇研究结果示TIMP对纳入早产儿半岁后的神经发育评分有良好的预测效度（灵敏度：0.50～1.00;特异度：0.68～1.00）或相关度（r：0.36～0.44）,故TIMP有助于早期诊断。结论　TIMP作为一种功能性运动的评估方法,对早产儿远期神经发育结局具有良好的预测效度。     

广州地区1～12月龄健康婴儿肺功能的测定结果

目的　探讨 1～ 12月龄健康婴儿肺功能的发育情况。方法　将 140名 1～ 12个月的健康婴儿分成 4组 :1～ 2月、～ 4月、～ 7月、～ 12月组。用美国森迪公司 2 6 0 0型儿童肺功能仪测定肺功能值 ,包括用潮气流速容量曲线部分替代最大呼气流速容量曲线检测出的潮气量和反映大小气道功能的指标 ;利用被动流速容量技术测定呼吸系统静态顺应性、总气道阻力 ;用开放式氮冲洗的方法测定功能残气量。结果　本组婴儿各项肺功能测定值男女间差异无显著意义 (P >0 .0 5 ) ,通气功能、功能残气量、呼吸系统的静态顺应性随月龄增大而增大 ,与身高、月龄、体重密切相关 ,各组间差异有显著性意义 (P <0 .0 1) ,而反映大、小气道功能所有指标都相对稳定。结论　用潮气流速容量曲线部分代替最大呼气流速曲线可反映大小气道功能情况 ,其各项指标相对稳定 ,可作为观察呼吸系统疾患时肺功能变化情况的比较理想的指标。通气功能、功能残气量、呼吸系统静态顺应性、潮气呼气峰流速随月龄增大而增大 ,符合婴儿生长发育的规律 ,1～ 4月婴儿发育最快。     

婴儿运动能力测试在早产儿发育评估中的应用

目的通过运用婴儿运动能力测试(TIMP)方法评估不同孕周早产儿运动发育特点及相关性, 从而更好地根据TIMP测试结果制定个体化早期干预措施。方法对2019年6月至2021年7月在三二〇一医院出生并随访的43名足月健康儿和77名早产儿进行前瞻性研究, 早产儿按照出生胎龄分为早期早产组(39例)和晚期早产组(38例), 分别在胎龄40周及出生矫正年龄16周进行TIMP测评, 足月健康组出生16周龄行TIMP测评, 组间差异行方差分析或Mann-Whitney秩和检验, 相关性行Pearson相关分析。结果早期早产儿和晚期早产儿在胎龄40周[(65.74±6.52)分比(66.96±8.51)分]和矫正年龄16周[(101±10)分比(104±8)分]时TIMP评分差异均无统计学意义(均P>0.05);矫正年龄16周时足月组TIMP值[(108±10)分], 与早期和晚期早产儿比较差异有统计学意义(P<0.05), 其中, 早期早产组和晚期早产组的观察、仰卧位、仰卧位翻身3部分TIMP评分较足月组降低(均P<0.05), 立位部分值较足月组升高(P<0.05);早期早...     

婴儿先天性心脏病1387例外科治疗结果分析

目的 回顾性分析我院近11年来外科治疗的≤6个月小婴儿先天性心脏病(先心病)1387例,探讨其病种、手术时机和治疗观念的变迁,以期进一步提高小婴儿先心病的就诊和救治率.方法 1997年1月至2007年12月,在我院行手术治疗的≤6个月先心病患儿1387例,主要病种包括:室间隔缺损合并肺动脉高压(VSD/PH)、法洛四联症(TOF)、完全性大动脉转位(TGA)、完全性肺静脉异位引流(TAPVC)、主动脉缩窄或主动脉弓中断合并室间隔缺损[CoA(IAA)/VSD]、右心室双出口(DORV)、合并室间隔缺损的肺动脉闭锁(PA/VSD)、室间隔完整的肺动脉闭锁(PA/IVS)等,根据病情采取相应的手术方法矫治,部分复杂型先心病进行了随访.结果 手术死亡110例,总手术死亡率7.9%.从历年手术治疗分析,手术死亡率1997至2003年为11.5%～14.4%,2004至2005年降至8.6%～&9%,2006至2007年降至3.3%～3.8%.对TGA、TAPVC、TOF、PA/VSD、PA/IVS患儿进行了随访,随访率分别为83.8%(98/117)、87.8%(79/90)、48.2%(68/141)、65%(13/20)和95%(19/20),随访期限为3～86个月.晚期死亡16例.随访中绝大多数患儿无症状,心功能和生长发育正常.结论 绝大部分早期出现症状的危重先心病可以在小婴儿期进行矫治,手术效果接近国际水平.不能进行一期矫治的可以先做姑息手术,改善缺氧、促进肺动脉发育,为以后的根治手术创造条件.     

婴儿异常运动功能评定表的信度和平行效度研究

目的　评价新编制的“婴儿异常运动功能评定表”重测信度、内部一致信度和平行效度 ,为应用该评定表在婴儿期筛查脑瘫提供简便、可行的工具。方法　对 16例 6～ 9个月龄的脑瘫患儿间隔 1～ 2周评定“婴儿异常运动功能评定表”的重测信度 ,对 36例 1岁内脑瘫患儿检查 ,计算Kuder Richardson系数 (rKR2 0 ) ,评价内部一致性信度。对 16例 6～ 9个月的脑瘫患儿和 6 8例 6个月正常婴儿分别用“婴儿异常运动功能评定表”和Morgan等编制的“早期运动模式量表”进行评定 ,分析两者评分相关性和对脑瘫患儿的区分能力。结果　“婴儿异常运动功能评定表”重测一致率为 97.1% ,Kappa值为 0 92 ;运动里程碑和神经反射 (原始反射与姿势反应 )rKR2 0 分别为0 5 4和 0 6 9。与“早期运动模式量表”同时对脑瘫患儿评分的相关系数为 0 85 (tr=3.0 5 34,P =0 0 0 0 ) ,“婴儿异常运动功能评定表”和“早期运动模式量表”对脑瘫患儿的区分能力分别为 10 0 % (16 / 16 )和 87.5 % (14 / 16 )。结论　“婴儿异常运动功能评定表”信度满意 ,其平行效度不低于国外用于脑瘫早期筛查的量表。     

中国0～13周婴儿体重身长和头围的生长参照值

目的 制订中国0～13周婴儿体重、身长和头围的生长参照值.方法 选择"2005年九市7岁以下儿童体格发育调查"中城区18 848名正常0～6个月龄婴儿的体重、身长和头围的测量值建立数据库,测量数据用标准化的测量方法和质量控制程序获得.采用LMS法对原始数据进行拟合修匀,通过L、M、S 3个参数计算产生所需要的百分位数值并绘制相应的生长曲线.增长值根据修匀后数据计算获得.结果 获得中国0～13周男、女婴儿每周龄的体重、身长和头围的生长参照值,按P3、P10、P25、P50、P75、P90及P97列表.此参照值反映的生长趋势与世界卫生组织(WHO)标准一致,总体上体重、身长略高于WHO生长标准,头围差异较小.结论 本研究提供的0～13周婴儿的体重、身长和头围生长参照值具有国家代表性,可供儿科临床、儿童保健以及科研工作等参照使用.     

Longitudinal Performance of Infants with Cerebral Palsy on the Test of Infant Motor Performance and on the Alberta Infant Motor Scale

Understanding the natural history of development in children with cerebral palsy (CP) is important for studying the consequences of early intervention. The purpose of this paper is to present results on the Test of Infant Motor Performance (TIMP) from 0-4 months of age and on the Alberta Infant Motor Scale (AIMS) from 3 to 12 months of age in a group of infants later diagnosed as having CP. Ages at which infants with CP were first recognized as having delayed motor performance on each instrument and the stability of performance over time are presented. Clinical implications for using both instruments are discussed.     

Prediction of gross motor development and independent walking in infants born very preterm using the Test of Infant Motor Performance and the Alberta Infant Motor Scale

Background

One objective of a neonatal follow-up program is to examine and predict gross motor outcome of infants born preterm.

Aims

To assess the concurrent validity of the Test of Infant Motor Performance (TIMP) and the Alberta Infant Motor Scale (AIMS), the ability to predict gross motor outcome around 15 months corrected age (CA), and to explore factors associated with the age of independent walking.

Methods

95 infants, born at a gestational age < 30 weeks, were assessed around 3, 6 and 15 months CA. At 3 months CA, correlations of raw-scores, Z-scores, and diagnostic agreement between TIMP and AIMS were determined. AIMS-score at 15 months CA and parental-reported walking age were outcome measures for regression analyses.

Results

The correlation between TIMP and AIMS raw-scores was 0.82, and between Z-scores 0.71. A cut-off Z-score of − 1.0 on the TIMP had 92% diagnostic agreement (κ = 0.67) with an AIMS-score < P10. Neither TIMP- nor AIMS-scores at 3 months CA were associated with the gross motor outcome at 15 months CA. The AIMS-scores at 6 months CA predicted the AIMS-scores at 15 months CA with an explained variance of 19%. Median walking age was 15.7 months CA, with which only the hazard ratio of the AIMS at 6 months CA and ethnicity were significantly associated.

Conclusions

Prediction of gross motor development at 15 months CA and independent walking was not possible prior to 6 months CA using the AIMS, with restricted predictive value. Cultural and infant factors seem to influence the onset of independent walking.     

Measurement and Prediction of Motor Proficiency in Children Using the Bayley Infant Scales and the Bruininks-Oseretsky Test

A sample of 76 Irish girls and boys of about 9 years of age, for whom neonatal (birthweight, Apgar and Neonatal Behavioural Assessment Scale) and infancy measures (Bayley Infant Scales at 18 months) were available, were administered the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP). The main focus of this paper is on a longitudinal analysis of the relationships between the neonatal and infancy measures and the BOTMP administered at about 9 years. However, since the literature expresses some doubts about the basis of the division of the BOTMP subtests into fine motor and gross motor groups and about the meaningfulness of the overall battery score, an initial statistical analysis was undertaken to examine these construct validity issues with this sample of children. This analysis indicated that the division of subtests into fine motor and gross motor skills groups, as formulated by the BOTMP, is not supported. The longitudinal analysis, therefore, focused mainly on subtest scores and provided some evidence of a degree of continuity in measured motor proficiency between birth, 18 months and the prepubertal period. Continuity was more evident for female children.     

Longitudinal performance of infants with cerebral palsy on the Test of Infant Motor Performance and on the Alberta Infant Motor Scale

Understanding the natural history of development in children with cerebral palsy (CP) is important for studying the consequences of early intervention. The purpose of this paper is to present results on the Test of Infant Motor Performance (TIMP) from 0-4 months of age and on the Alberta Infant Motor Scale (AIMS) from 3 to 12 months of age in a group of infants later diagnosed as having CP. Ages at which infants with CP were first recognized as having delayed motor performance on each instrument and the stability of performance over time are presented. Clinical implications for using both instruments are discussed.     

Early gross motor development of preterm infants according to the Alberta Infant Motor Scale

OBJECTIVE: To systematically examine gross motor development in the first 18 months of life of preterm infants. STUDY DESIGN: A total of 800 preterm infants (356 boys), ages between 1 and 18 months and corrected for degree of prematurity, were assessed with the use of the Alberta Infant Motor Scale. RESULTS: Comparison of the mean Alberta Infant Motor Scale scores of the preterm infants with the norm-referenced values derived from term infants revealed that as a group, the preterm infants scored significantly lower at all age levels, even with full correction for degree of prematurity. CONCLUSIONS: In general, preterm infants exhibit different gross motor developmental trajectories compared with term infants in the first 18 months of life. The gross motor developmental profile of preterm infants may reflect a variant of typical gross motor development, which seems most likely to be specific for this population. As a consequence, adjusted norms should be used for proper evaluation and clinical decision-making in relation to preterm infants.     

Gross motor development in full-term Greek infants assessed by the Alberta Infant Motor Scale: Reference values and socioeconomic impact

Objective

The aims of this study were to investigate gross motor development in Greek infants and establish AIMS percentile curves and to examine possible association of AIMS scores with socioeconomic parameters.

Methods

Mean AIMS scores of 1068 healthy Greek full-term infants were compared at monthly age level with the respective mean scores of the Canadian normative sample. In a subgroup of 345 study participants, parents provided, via interview, information about family socioeconomic status. Multiple linear regression analysis was performed to evaluate the relationship of infant motor development with socioeconomic parameters.

Results

Mean AIMS scores did not differ significantly between Greek and Canadian infants in any of the 19 monthly levels of age. In multiple linear regression analysis, the educational level of the mother and also whether the infant was being raised by grandparents/babysitter were significantly associated with gross motor development (p = 0.02 and p < 0.001, respectively), whereas there was no significant correlation of mean AIMS scores with gender, birth order, maternal age, paternal educational level and family monthly income.

Conclusions

Gross motor development of healthy Greek full-term infants, assessed by AIMS during the first 19 months of age, follows a similar course to that of the original Canadian sample. Specific socioeconomic factors are associated with the infants' motor development.     

Infanib对新生儿重症监护病房出院早产儿早期运动发育及预后评估

目的：探讨 Infant Neurological International Battery (Infanib)对新生儿重症监护病房出院的高危早产儿后期运动发育异常的预测效度。方法：纳入对象为 2008年6月至2010年3月入住新生儿重症监护病房治疗出院的早产儿,在纠正年龄3~4月、6~7月龄时采用 Infanib 进行运动发育评估;在纠正年龄12月龄或12月龄以上采用 Peabody 运动发育量表或临床神经学体检评估运动结局。通过计算 Infanib 对后期运动发育结局评估的敏感性、特异性、阳性预测值以及阴性预测值等进行预测效度评价。结果：共147例早产儿参与临床随访,在纠正年龄3~4月、6~7月龄时进行 Infanib 评估的患儿分别为147例、117例;纠正年龄12月龄或12月龄以上 129例。最终运动发育正常90例(69.8％),运动发育落后 28例(21.7％),脑瘫 11例(8.5％)。纠正年龄3~4月龄和6~7月龄 Infanib评估对运动发育异常的敏感性分别为84.6％、100％;特异性75.6％、91.7％;阳性预测值60.0％、82.5％;阴性预测值91.9%、100％。结论：Infanib 可以用于早产儿运动发育的早期评估,并具有较好的预测效度。     

Concurrent Validity and Reliability of the Alberta Infant Motor Scale in Infants at Dual Risk for Motor Delays

Concurrent validity of scores for the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Gross Motor Scale-2 (PDGMS-2) was examined with a sample of 35 infants at dual risk for motor delays or disabilities. Dual risk was defined as low birthweight (≤ 1,500 g at birth) and environmental risk (children from low-income families). Measures were administered to participants during one visit to a high-risk, follow-up program. Pearson product-moment correlation coefficients were high (r = .90 to .97), with the highest correlation between PDGMS-2 locomotion subscale and AIMS total score. Correlation coefficients were lower for infants > 9 months of age. Novice examiners' scores on both measures closely approximated those of experienced examiners (ICC range = .98 to .99). The results support concurrent validity of the AIMS and PDGMS-2 for infants at dual risk and have implications for using the AIMS in high-risk follow-up programs, particularly in relation to evaluating functional components of motor performance and ease of administration.