全身运动质量评估联合Dubowitz神经学检查在窒息早产儿神经发育评估中的应用

目的 分析全身运动质量评估(GMs)联合Dubowitz神经学检查在窒息早产儿神经发育评估中的应用价值。方法 选取2017年2月-2018年3月在南通大学附属医院新生儿病房治疗的60例窒息早产儿为研究对象,根据2012年早产儿脑损伤专家共识将研究对象分为脑损伤组(n=28)、非脑损伤组(n=32),分别于生后7 d内(至少2次)、纠正胎龄满40周行Dubowitz神经学检查,在足月前阶段、扭动运动阶段以及不安运动阶段行GMs的初筛和复筛,在纠正胎龄3个月、6个月及12个月时行婴幼儿智能发育量表测定(CDCC)。分析GMs联合Dubowitz神经学检查在窒息早产儿脑损伤中的早期诊断价值及与CDCC的相关性。结果 1)GMs联合Dubowitz神经学检查预测窒息早产儿脑损伤的灵敏度为96.43%,特异度为84.38%。2)GMs联合Dubowitz对早产儿脑损伤的筛查阳性率与纠正胎龄满3个月、6个月、12个月时CDCC(PDI、MDI)评分均具有正相关性(r=0.71、0.66;0.67、0.59;0.73、0.71),其中与12个月CDCC相关性最强。结论 GMs联合Dubowitz神经学检查可作为窒息早产儿脑损伤早期诊断的有效手段。

Application of general movements combined with Dubowitz neurological examination in evaluating neurodevelopmental outcomes of premature asphyxiated infants

Objective To analyze the application value of general movements(GMs) combined with Dubowitz neurological examination in the evaluation of neurodevelopment in asphyxiated premature infants. Methods A total of 60 premature asphyxiated infants treated in the neonatal ward of the Affiliated Hospital of Nantong University from February 2017 to March 2018 were enrolled in the study,and were divided into brain injury group(n=28) and non-brain injury group(n=32)according to the consensus of experts on brain injury of premature infants in 2012. Dubowitz neurological examination was performed at least twice within 7 days after birth and 40 weeks after correcting gestational age. GMs screening and re-screening were performed in the pre-term stage,writhing movements stage and fidgety movements stage.Children′s Developmental Center of China(CDCC) was conducted at the corrected age of 3,6 and 12 months old.The early diagnostic value of GMs combined with Dubowitz neurological examination in brain injury of premature infants with asphyxia and its correlation with CDCC were analyzed. Results 1)The sensitivity and specificity of GMs combined with Dubowitz neurological examination in predicting brain injury in premature infants with asphyxia were 96.43% and 84.38%,respectively. 2)The positive rate of GMs combined with Dubowitz in screening for brain injury in premature infants was positively correlated with the CDCC(PDI、MDI) score at 3,6 and 12 months of gestational age (r=0.71,0.66;0.67,0.59;0.73,0.71),and the correlation was the strongest at 12 months. Conclusion GMs combined with Dubowitz neurological examination can be used as an effective means for early diagnosis of brain injury in premature infants with asphyxia.