不安运动阶段对早产儿运动发育结局的预测价值

Predictive value of fidgety movements assessment for motor development outcomes in premature infant

目的比较全身运动质量评估(General movements assessment,GMs)不安运动阶段和Gesell发育量表(Gesell Developmental Test Scales,GDS)对早产儿运动发育结局的预测效度,及对两种评估方法和发育结局的一致性检测。方法对2011年6月-2013年6月共226例在本院儿童保健科随访的早产儿,在纠正5个月内采用GMs和GDS进行评估,在纠正12个月时临床诊断是否为脑瘫,并使用Peabody运动发育量表(Peabody Development Motor Scale 2,PDMS-2)确定其运动发育结局。对比分析两种评估方法的预测效度(包括敏感度、特异度、阳性预测值和阴性预测值),及与发育结局的相关性。结果 226例早产儿发育结局中运动发育正常176例,运动发育迟缓22例,脑瘫28例。不安运动阶段评估结果为正常者168例,异常为58例;GDS评估结果为正常者140例,异常为86例。不安运动及GDS预测脑瘫敏感度92.9%、71.4%,特异度83.8%、66.7%,阳性预测值44.8%、23.3%,阴性预测值98.8%、94.3%。不安运动及GDS预测运动发育结局敏感度88.0%、68.0%,特异度92.0%、70.4%,阳性预测值75.9%、39.5%,阴性预测值96.4%、88.6%。GDS和PDMS-2的一致性检验Kappa值0.306,P<0.05,GMs和PDMS-2评估的一致性检验Kappa值0.757,P<0.05,提示GMs、GDS对运动发育预测与发育结局均具有良好的一致性,GMs中不安运动阶段的预测与发育结局的一致性更高。结论 GMs的不安运动阶段能够超早期预测脑瘫等不良运动发育结局,在预测预后方面要优于GDS,能更早期的做出预测。

Objective To compare the validity and concordance in the motor developmental outcomes of General Movements assessment （GMs） with that of Gesell Developmental Test Scale （GDS）among premature infants. Methods 226 premature infants doing physical examination and follow-up in Department of Children＇s Health Care of our hospital during June 2011 to June 2013 were evaluated with GMs assessment and Gesell Developmental Test Scale. Cerebral palsy was evaluated and the motor development was assessed by Peabody Development Motor Scale 2 （PDMS-2） in correct gestational age 12 month. Compare the predictive validity （sensitivity, specificity, positive predictive value and negative predictive value） and motor development of the two methods. Results There were 28 cerebral palsy patients and 22 infants with motor retarda- tion among the 226 premature infants, meanwhile 176 were normal. For the fidgety movements of GMs, 168 infants were assessed as normal, 58 were abnormal. GDS assessment results：There were 140 infants were assessed as normal and 86 infants were abnormal. The fidgety movements of GMs assessments and GDS assessment sensitivity for cerebral palsy was 92.9 %, 71.4% ,its specificity was 83.8% ,66.7% ,its positive predictive value was 44.8% ,23.3% ,its negative predictive value was 98.8%o ,94.3%. The fidgety movements of GMs assessments and GDS assessment sensitivity for motor development outcome was 88.0% ,68.0% ,its specificity was 92.0% ,70.4% ,its positive predictive value was 75.9% ,39.5% ,its negative predictive value was 96.4%,88.6 %. The Kappa value for consistency checks of GDS and PDMS-2 was 0. 306, P〈0.05. The Kappa value for consistency checks of GMs and PDMS-2 was 0. 757 ,P〈0.05. The results hint that a good consistency of GMs and GDS and PDMS-2. The consistency of prediction and assessment result of fidgety movements was higher than other methods. Conclusions Fidgety movements of GMs can make early prediction of cerebral palsy and other severe neurological deficits. It is better than the traditional method neurological examination in predicting prognosis.