全身运动质量评估在高危儿随访中的作用

Role of qualitative general movements assessment for follow-up in high risk infants

目的:探讨全身运动(GMs)质量评估在高危儿随访中的作用。方法:选择在儿童保健科门诊随访的高危儿,分扭动运动阶段和不安运动阶段,运用0~6岁小儿神经心理发育量表结合临床诊断确定是否有脑性瘫痪(脑瘫)、发育迟缓和发育偏离。并随访至12月龄以上有明确的随访结局。计算GMs质量评估的预测效度。结果:160名高危儿随访结局:脑瘫11例(6.9%),发育迟缓32例(20.0%),发育偏离58例(36.3%),发育正常59例(36.8%)。GMs评估对神经学发育异常的预测效度:扭动阶段敏感性73.27%,特异性55.93%,阳性预测值74.00%,阴性预测值55.00%;不安阶段敏感性16.83%,特异性100.00%,阳性预测值100.00%,阴性预测值41.26%。结论:GMs质量评估结合0~6岁小儿神经心理发育量表,并坚持长期随访,可协助临床预测高危儿神经学发育结局,对高危儿早期干预起到指导作用,值得推广。

Objective:To explore the role of qualitative general movements(GMs)assessment for follow-up in high risk infants.Methods:High risk infants followed up in outpatient department of child health care were selected and evaluated by GMs assessment in writhing movements and fidgety movements period.The neuropsychological developmental scale for children aged 0-6 years was used to determine whether there was cerebral palsy,developmental delay and developmental deviation by combining with clinical diagnosis.The patients were followed up for more than 12 months.The predictive validity of GMs assessment was calculated.Results:The follow up results of 160 high risk infants showed that cerebral palsy in 11 cases(6.9%),developmental delay in 32 cases(20.0%),developmental deviation in 58 cases(36.3%),normal development in 59 cases(36.8%)were found.The predictive validity of GMs assessment for neurodevelopmental abnormality in the writhing movements period was as follows:sensitivity 73.27%,specificity 55.93%,positive predictive value74.00%,and negative predictive value 55.00%.The predictive validity of GMs assessment for neurodevelopmental abnormality in the fidgety movements period was as follows:sensitivity 16.83%,specificity 100.00%,positive predictive value 100.00%,and negative predictive value 41.26%.Conclusions:GMs assessment combined with the neuropsychological developmental scale for children aged 0-6 years and long-term follow-up can help to predict neurological outcome of high risk infants,and guide the early intervention in high risk infants,which is worth promoting.