早产儿神经发育评估的进展

doi:10.11852/zgetbjzz2022-0574

摘要/Abstract

摘要： 随着医学的发展,为了改善早产儿(尤其超早产儿)的神经发育不良结局,较多的检测手段如脑结构、代谢、功能等检测及神经行为评估量表等应用,以期早期发现早产儿相关的神经发育障碍。近些年,头颅超声、头颅MRI在临床上的应用得到共识,振幅整合脑电图、脑干听觉诱发电位、全身运动评估及Alberta婴儿运动量表、NBNA评分等在临床上得到较多应用,静息态功能磁共振、Dubowitz神经学评估法及Hammersmith神经评估方法逐渐进入早产儿领域。本文对相关的检测手段及相关评估方法的特点、以及在临床联合应用方面进行了探讨。

关键词: 早产儿, 神经发育障碍, 联合评估

Abstract: With the development of medical science, more methods are used for the early detection of neurodevelopmental impairment in premature infants in order to improve their neurodevelopmental outcomes, such as the examination in brain structure, metabolism, neurological function and the application of neurobehavioral assessment scales. In recent years, cranial ultrasound and cranial MRI are widely used in clinic, amplitude-integrated EEG, brainstem auditory evoked potentials,whole-body motor assessment and the Alberta Infant Movement Scale and Neonatal Behavioral Neurological Assessment(NBNA) score have been used more often in clinical practice, resting-state functional magnetic resonance imaging, Dubowitz Neurological Assessment Method and Hammersmith Neurological Assessment Method have been gradually used in premature infants. In this paper, the characteristics and clinical application of these assessment methods are discussed.

Key words: premature infants, neurodevelopmental impairment, joint assessment

中图分类号:

R174

王娜, 李晓莺. 早产儿神经发育评估的进展[J]. 中国儿童保健杂志, 2023, 31(4): 404-407.

WANG Na, LI Xiaoying. Progress in neurodevelopmental assessment of premature infants[J]. Chinese Journal of Child Health Care, 2023, 31(4): 404-407.

参考文献

[1] Colvin M, McGuire W, Fowlie PW. Neurodevelopmental outcomes after preterm birth[J]. BMJ,2004,329(7479):1390-1393.
[2] 黄胜,黄托夫,娄普,等.早产儿生后早期头颅磁共振成像结果预测远期脑性瘫痪价值的Meta分析[J].中华围产医学杂志,2012,15(3):132-139.
Huang S,Huang TF,Lou P,et al.Diagnostic accuracy of early brain magnetic resonance imaging for predicting cerebral palsy in premature infants:A Meta-analysis[J].Chin J Perinat Med,2012,15(3):132-139.
[3] Miller SP, Ferriero DM, Leonard C, et al. Early brain injury in premature newborns detected with magnetic resonance imaging is associated with adverse early neurodevelopmental outcome[J]. J Pediatr, 2005, 147(5):609-616.
[4] 桑田, 王颖, 王红梅, 等.极低/超低出生体重早产儿头颅超声检查与神经发育评估的关系[J].中华新生儿科杂志,2020,35(1):4-9.
Sang T,WangY,Wang Hm,et al.Cranial ultrasonography:Its role in the evaluation of neurodevelopmental outcomes in preterminfants with birth weight less than 1 500 grams[J] .Chin J Neonatol,2020,35(1):4-9.
[5] Dubois J,Dehaene-Lambertz G,Kulikova S, et al. The early development of brain white matter:A review of imaging studies in fetuses, newborns and infants[J]. Neuroscience, 2014, 276(9):48-71
[6] Konkel L. The brain before birth:Using fMRI to explore the secrets of fetal neurodevelopment[J].Environ Health Perspect, 2018,126(11):1-5.
[7] Weinstein M, Ben-Sira L, Moran A, et al. The motor and visual networks in preterm infants:An fMRI and DTI study[J].Brain Res, 2016, 1642:603-611.
[8] Ellis CT, Turk-Browne NB. Infant fMRI:A model system for cognitiveneuroscience[J].Trends Cogn Sci,2018,22(5):375-387.
[9] Wikström S, Pupp IH, Rosén I, et al. Early single-channel aEEG/EEG predicts outcome in very preterm infants[J].Acta Paediatr,2012,101(7):719-726.
[10] Scoppa A,Casani A,Cocca F,et al.aEEG in preterm infants[J]. J Matern Fetal Neonatal Med, 2012, 25(Suppl 4):139-140.
[11] Soubasi V,Mitsakis K,Sarafidis K,et al.Early abnormal amplitude-integrated electroencephalography (aEEG) is associated with adverse short-term outcome in premature infants[J]. Eur J Paediatr Neurol, 2012,16(6):625-630.
[12] Hüning B,Storbeck T,Bruns N,et al.Relationship between brain function (aEEG) and brain structure (MRI) and their predictive value for neurodevelopmental outcome of preterm infants[J].Eur J Pediatr,2018, 177(8):1181-1189.
[13] Wang X, Carroll X, Wang H, et al. Prediction of delayed neurodevelopment in infants using brainstem auditory evoked potentials and the Bayley Ⅱ scales[J]. Front Pediatr, 2020,8(485):1-14.
[14] 郭异珍.早产儿的脑干听觉诱发电位的特征、规律及在听力筛查中的作用[J].中华儿科杂志,1996,34(3):30-33.
Guo YZ.Characteristics of auditory brainstem response in preterm infants and its significance in hearing screening[J].Chinese Journal of Pediatrics,1996,34(3):30-33.
[15] 梁树艺,臧菲菲,杨红,等.全身运动评估对双胎多胎早产儿脑性瘫痪发育结局的预测效度研究[J].中华物理医学与康复杂志,2017,39(4):264-266.
Liang SY, Zang FF,Yang H,et al.The fidgety general movement assessment can predict motor development outcomes for preterm twins or multiplets[J].Chin J Phys Med Rehabil,2017,39(4):264-266.
[16] 张华清. NBNA评分在早产儿脑发育预后评估中的应用[D].沈阳:中国医科大学,2019.
Zhang HQ.NBNA is applied in evaluating the prognosis of brain development of preterm infants[D].Shenyang:China Medical University,2019.
[17] Piper MC,Pinnell LE, Darrah J, et al. Construction and validation of the Alberta Infant Motor Scale (AIMS)[J]. Can J Public Health, 1992, 83(Suppl):46-50.
[18] 林碧云,危曼,邵肖梅,等.Alberta婴儿运动量表对新生儿重症监护室高危儿出院后筛查运动发育落后的准确性研究[J].中国循证儿科杂志,2015,10(2):81-84.
Lin BY,Wei M,Shao XM,et al.The accuracy of Alberta Infant Motor Scale in screening motor development delay in the follow-up of high risk infants discharged from NICU[J].Chinese Journal of Evidence-Based Pediatrics,2015,10(2):81-84.
[19] Fuentefria RN,Silveira RC,Procianoy RS.Motor development of preterm infants assessed by the Alberta Infant Motor Scale:Systematic review article[J].J Pediatr (Rio J),2017, 93(499):1-15.
[20] Dubowitz L, Ricciw D, Mercuri E.The Dubowitz neurological examination of the full-term newborn[J].Ment Retard Dev Disabil Res Rev, 2005,11(1):52-60.
[21] 林森然,李筠,崔娓,等.晚期早产儿Dubowitz神经学评估法与发育行为结局的关联性研究[J].中国儿童保健杂志,2018,26(7):705-708.
Lin SR,Li Y,Cui W,et al.Research on the association between Dubowitz neurological assessment and the outcome of developmental behavior in late-preterm infants[J].Chin J Child Health Care,2018,26(7):705-708.
[22] Romeo DM,Ricci D,Brogna C,et al.Use of the Hammersmith Infant Neurological Examination in infants with cerebral palsy:a critical review of the literature[J].Dev Med Child Neurol,2016,58(3):240-245.
[23] Romeo DM, Cowan FM,Haataja L,et al.Hammersmith Infant Neurological Examination for infants born preterm:predicting outcomes other than cerebral palsy[J].Dev Med Child Neurol,2021,63(8):939-946.
[24] deVries LS, Benders MJNL, Groenendaal F.Imaging the premature brain:ultrasound or MRI?[J].Neuroradiology,2013,55(2):13-22.
[25] Ibrahim J, Mir I, Chalak L.Brain imaging in preterm infants< 32 weeks gestation:A clinical review and algorithm for the use of cranial ultrasound and qualitative brain MRI[J].Pediatr Res,2018,84(6):799-806.
[26] Arichi T, Whitehead K, Barone G, et al. Localization of spontaneous bursting neuronal activity in the preterm human brain with simultaneous EEG-fMRI[J].Elife,2017,6(9):1-23.
[27] 王翠,李一芳,黄真,等.Alberta婴儿运动量表与Peabody粗大运动发育量表在高危儿中的预测能力研究[J].中国康复医学杂志,2019,34(3):293-296.
Wang C, Li YF, Huang Z, et al.Psychometrics study of Alberta infant motor scale and Peabody developmental gross motor scale in high risk infants[J].Chinese Journal of Rehabilitation Medicine,2019,34(3):293-296.