目的 探讨不安运动阶段全身运动评估(GMs)对足月小样儿不良运动发育结局的预测价值以期为早期康复干预提供依据。方法 回顾性纳入在复旦大学附属儿科医院康复科就诊的足月小样儿61例,通过检索科室GMs儿科诊疗应用系统数据库或经电话、微信等形式获取研究对象在其他医院已明确的12月龄以上的运动发育结局作为本研究所纳入的最终结局。分析不安运动阶段全身运动评估对脑性瘫痪、不良运动发育结局(脑性瘫痪和运动发育迟缓)的预测敏感性、特异性、阳性预测值及阴性预测值。结果 纳入研究的61例足月小样儿GMs评估结果中,18例为不安运动缺乏,43例为正常不安运动。运动发育随访结局中7例临床诊断为脑性瘫痪,11例临床诊断为运动发育迟缓,43例运动发育达到正常水平。GMs评估(不安运动阶段)对足月小样儿是否发展成为脑性瘫痪的预测效度为:敏感性100％、特异性97.67％、阳性预测值87.5％、阴性预测值100％;对足月小样儿是否发展成为不良运动的预测效度为:敏感性94.44％、特异性97.67％、阳性预测值94.44％、阴性预测值97.67％。结论 不安运动阶段全身运动评估对足月小样儿运动发育结局(尤其是脑瘫)具良好的预测价值,作为一种非侵入性、非干扰性的新型神经运动评估工具,可在足月小样儿脑发育随访工作中推广应用。
Abstract
Objective To explore the predictive validity of the general movements assessment (GMA) in fidgety period for motor development outcome in small for gestational age (SGA) infants, in order to provide evidence for early rehabilitation intervention.Methods A total of 61 SGA infants were retrospectively analyzed in Department of Rehabilitation of Children's Hospital of Fudan University. The motor development outcomes after 12 months were obtained by searching the database of the pediatric diagnosis and treatment application system in the department or by telephone and WeChat. The sensitivity, specificity, positive predictive value and negative predictive value of GMA for motor development outcome (cerebral palsy and motor development delay) were analyzed.Results Among 61 GMA results, 18 GMA results were identified as fidgety movement absent (F-) and 47 GMA results as normal fidgety movement (NF). In the follow-up of motor development, 7 cases were clinically diagnosed with cerebral palsy and 11 cases with motor development delay, while 43 cases had normal motor development. The sensitivity, specificity, positive predictive value and negative predictive value of GMA for cerebral palsy were 100%, 97.67%, 87.5% and 100%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of GMA for motor development outcome (cerebral palsy and motor development delay) were 94.44%, 97.67%, 94.44% and 97.67%, respectively.Conclusion The GMA in fidgety period has a good predictive validity for the abnormal motor developmental outcomes, especially for cerebral palsy. As a new non-invasive and unobtrusive assessment tool, GMA can be widely used in the follow-up work of brain development in SGA infants.
关键词
全身运动评估 /
足月小样儿 /
运动发育结局 /
预测效度
Key words
general movements /
small gestational age infants /
motor developmental outcome /
predictive validity
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Ji HJ, Yong HC, Jeong HW, et al. Fetal doppler to predict cesarean delivery for non-reassuring fetal status in the severe small-for-gestational-age fetuses of late preterm and term [J] .Obstet Gynecol Sci,2018,61(2):202-208.
[2] Tamura N, Hanaoka T, Ito K et al. Different risk factors for very low birth weight,term-small-for-gestational-age, or preterm birth in Japan [J] .Int J Environ Res Public Health,2018,15(2):369.
[3] Griffin M, Seed PT, Duckworth S, et al. Predicting delivery of a small-for-gestational-age infant and adverse perinatal outcome in women with suspectedpreeclampsia [J] .Ultrasound Obstet Gynecol,2018,51(3):387-395.
[4] 王玉芳, 戚锋锋, 蒋琦.足月小样儿行为神经发育评估及与血糖水平间关系的研究 [J] .中国儿童保健杂志,2011,19（9）：840-842.
[5] Clayton PE, Cianfarani S, Czernichow P et al. Management of the child born small for gestational age through to adulthood:a consensus statement of the international societies of pediatric endocrinology and the growth hormone research society [J] .J Clin Endocrinol Metab,2007,92(3):804-810.
[6] 杨红, 邵肖梅.全身运动评估 [J] .中国循证儿科杂志,2007,2(2)：138-143.
[7] Novak I, Morgan C, Adde L, et al. Early, accurate diagnosis and early intervention in cerebral palsy [J] .JAMA Pediatr,2017,171(9):897-907.
[8] 陈鸣, 杨红, 侯方华, 等. 全身运动评估对极低出生体重早产儿运动发育结局的预测价值 [J] .中国儿童保健杂志,2012,20（12）：1067-1069.
[9] 臧菲菲,杨红,曹佳燕,等. 扭动运动全身运动评估在极低出生体重早产儿运动发育随访中的应用研究 [J] .中国儿童保健杂志,2015,23（5）：530-533.
[10] 尹欢欢, 杨红, 曹佳燕, 等. 全身运动细化评估在高危儿运动发育中的信度研究 [J] .中国儿童保健杂志,2017,25（3）：230-233.
[11] Einspieler C, Prechtl HF. Prechtl′s assessment of general movements:a diagnostic tool for the functional assessment of the young nervous system [J] .Ment Retard Dev Disabil Res Rev,2005,11(1):61-67.
[12] 李立明.流行病学 [M] .4版.北京：人民卫生出版社,2000:52-57.
[13] Zang FF, Yang H, Han Q, et al. Very low birth weight infants in China:the predictive value of the motor repertoire at 3 to 5 months for the motor performance at 12 months [J] .Early Hum Dev,2016,100(2016):27-32.
[14] 中国康复医学会儿童康复专业委员会,中国残疾人康复协会小儿脑性瘫痪康复专业委员会,《中国脑性瘫痪康复指南》编委会.中国脑性瘫痪康复指南2015（第二部分） [J] .中国康复医学杂志,2015,30（8）：858-866.
[15] Rachel B, Garey N, Nathalie M. Implementation of early diagnosis and intervention guidelines for cerebral palsy in a high-risk infant follow-up clinic [J] .Pediatric Neurology,2017,76:66-71.
[16] Aylward GP. Neurodevelopmental outcomes of infants born prematurely [J] .J Dev Behav Pediatr,2014,35(6):394-407.
[17] 杨红,史惟,邵肖梅,等.全身运动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）：172-179.
[18] Olsen J, Marschik P, Spittle A .Do fidgety general movements predict cerebral palsy and cognitive outcome in clinical follow-up of very preterm infants? [J] .Acta Paediatr,2018,107(2):361-362.
PDF(758 KB)
