探讨健康足月新生儿NBNA的影响因素

Influencing factors affecting NBNA scores among healthy full-term newborns

目的分析胎龄、日龄、体重及性别对健康足月新生儿行为神经测定(NBNA)的影响,并与常模数据进行比较,探讨NBNA的理想值范围。方法选择2009年11月至2012年6月河北省三河市妇幼保健院出生的健康足月儿,生后1周内行NBNA测定,对得分情况进行统计学描述,对不同胎龄、检查日龄、体重及性别之间NBNA总分的差异应用秩和检验,探讨NBNA总分的影响因素。并且对比分析本项目与1988年中国12城市健康新生儿NBNA评分的差异。结果共入选1345例健康足月新生儿,NBNA总分均在37分以上,平均(39.6±0.7)分。扣分项目主要出现在对光习惯的形成、对声音习惯的形成、握持反射及牵拉反应4个单项中,以牵拉反应扣分最多。不同胎龄、日龄、体重及不同性别之间NBNA总分差异无统计学意义(P>0.05)。但随胎龄增加,NBNA满分率有增加趋势。与1988年中国12城市健康新生儿NBNA评分结果进行比较,NBNA得分分布有显著差异,本项目得分无37分以下者,且39分及40分所占比例更高。结论 NBNA作为一种足月新生儿的行为神经评估方法,在健康足月儿中总分的分布不受性别、日龄及体重的影响,但NBNA评分的满分率存在随胎龄增加而增加的趋势。将生后7天以内新生儿NBNA总分35～36分视为正常须谨慎,足月新生儿NBNA评估中理想得分为37分以上。

Objective To investigate possible influences of gestational age （weeks）, chronological age （days）, birth weight and gender to the Neonatal Behavior and Neurological Assessment （NBNA） test scores among healthy full-term newborns ; and to reevaluate the optimal scores of NBNA in healthy full term infants by comparing to the published Norm values. Methods The current study enrolled all healthy full-term newborns born at the Sanhe Maternal and Child Hospital from November 2009 to June 2012. NBNA testing was performed on all infants within 7 days after birth. Possible influences of gestational age （weeks）, chronological age （days）, birth weight and gender to the NBNA scores were evaluated through statistical analysis. Score discrepancies between the results of our study and previously published results in 1988 among 12 cities in China were compared. Results All 1345 infants enrolled in the study obtained total NBNA score above 37 and with average score of 39.6 ＋ 0. 7. The top four reasons for score deduction were habitual response to light, and to Noise, Grasping Reflex and Traction Reaction; among those, Traction Reaction was the most deducted score. Total NBNA scores have no statistical differences among the infants with different gestational ages, chronological age in daysat the time of examination, weight, and gender （ P 〉 0. 05 ） ; however, higher percentage of infants achieved full NBNA score with increased gestational weeks. As previous published NBNA results in 1988 have stated that a NBNA total score of ≥35 as normal in healthy full term newborns, the current study has shown significant difference in the total score distribution： In the current study, all infants have achieved scores of ≥ 37, and a higher percentage of infants achieved scores of 39 or 40. Conclusions NBNA test score, as a clinical tool for evaluation of behavior and neurological development of full term healthy newborn infants, is not affected by gender, chronological age （ days within the first week of life） and birth weight; however, the likelihood of infants achieving full score increases with advancing in gestational age （weeks）. NBNA scores of ≥37 should be the optimal score in healthy full term newborn, whereas infants with scores of 35 -36 are likely at risk for behavior and neuro-developmental abnormalities.