危重早产儿行为神经测定与幼儿期智能测验

HIGH-RISK PREMATURE INFANTS' BEHAVIORAL NEUROLOGICAL ASSESSMENT AND THEIR INTELLIGENCE DEVELOPMENT IN YOUNG CHILDHOOD

本文对NICU中32例早产儿，胎龄24～36周，体重590～2500克，于纠正胎龄40周时进行了行为神经测定（NBNA），在入院时及住院期间进行生理稳定状态评分（PSI）及治疗干预评分（TISS）。疾病严重者，PSI及TISS评分高。患儿于2～3岁时进行CDCC婴幼儿智能测验，结果显示：（1）早产儿于纠正胎龄40周时NBNA≤36分者，PSI及TISS评分比NBNA37～40分者高，说明NBNA评分的高低，可以监测疾病的轻重。（2）NBNA20项中凡病情较重者最受影响的项目是：①行为能力方面的对红球的反应及说话人脸的反应；②主动肌张力方面的有头竖立、支持反应及牵拉反应。这显示，以上项目是反映病情较敏感的指标。（3）股龄越低，PSI及TISS评分越高，NBNA总分不正常越多。这与早产儿，尤其是胎龄越低的早产儿易合并各种疾病越多有关。（4）早产儿于纠正胎龄40周时NBNA等于或小于35分者，到2～3岁时CDCC智测，智能发展指数均为≤68，属智能缺陷儿。这提示NICN中早产儿早期发现NBNA评分低者，应积极进行早期干预。

In order to evaluate the significane of using the Premature lnfant Behavioral Neurological Assessment to assess the high－risk premature infants , thirty two infants of 24－36 weeksof gestation of age (GA) with birth weight between 590－2500g were evaluated on admissionand when they were most sick with the twenty－six item Physiologic Stability Index (PSI) andthe eighteen－item Therapeutic Intervention Scoring System (TISS). At the corrected GA of40 weeks, they were assessed with the twenty－item NBNA. Then at the age of 21/2 to 3years their intelligence development were assessed with the CDCC. It was found that: (1)PSI and TISS scoring were higher (i. e., infants more sick) in the NBNA scoring<36 groupthan in the NBNA scring 37－40 (normal) group, suggesting that NBNA can be used to monitor the severity of the sickness; and (2) all those scored 35 or less by NBNA at cor rected GAof 4o weeks were scored 68 or less by CDCC at the age of 21/2－3 years and migh1f thereforebe mental handicap. lt is highly recommended that high－risk premature infants with 1owNBNA score should be provide with intervention as early as possible