早期评估及干预在高危儿随访中的临床价值分析

Analysis of the clinical value of early assessment and intervention in the follow-up of high-risk infants

目的分析早期评估及干预在高危儿随访中的临床价值,为高危儿随访及干预提供新模式。方法选取2010年10月-2016年10月芜湖市第二人民医院儿童保健科门诊随访的160例高危儿,进行扭动阶段和不安阶段的全身运动(GMs)质量评估、月龄满3个月后运用0~6岁小儿神经心理发育检查表(简称"儿-心")定期测试发育商(DQ),随访至12月龄以上以临床诊断与随访评估结果明确其神经发育结局。对评估结果异常的实施早期干预。采用自身对照研究观察临床效果,分析两种评估结果的相关性及早期神经运动发育异常的相关影响因素。结果 1)神经学发育结局:发育正常59例(36.8%),发育偏离58例(36.3%),发育迟缓32例(20%),脑瘫11例(6.9%);2)干预前后扭动运动阶段GMs评估结果比较,差异有统计学意义(χ2=35.367,P<0.01);3)干预后高危儿的DQ明显高于干预前,差异有统计学意义(t=-4.593,P<0.01);4)GMs评估结果与"儿-心"量表得分均显著相关(P<0.05或<0.01);5)扭动运动阶段评估异常的高危因素为低出生体重(OR=7.650,95%CI:1.129~51.813,P=0.037)、缺氧缺血性脑病(OR=2.656,95%CI:1.158~6.089,P=0.027)、脑损伤(OR=2.123,95%CI:1.017~4.434,P=0.045)和早产(OR=2.405,95%CI:1.126~5.133,P=0.023)。结论运用全身运动质量评估结合"儿-心"量表进行早期评估,有助于预测高危儿神经学发育结局,并且对高危儿早期干预起指导作用。

Objective To explore the clinical value of early assessment and intervention in the follow-up of high-risk infants, so as to provide a new model for follow-up and intervention of high-risk infants. Methods Totally 160 high-risk children in Child Health Department of Wuhu Second People′s Hospital were selected to perform General Movements assessment(GMs) in writhing stage and restless stage from October 2010 to October 2016.When infants were 3 months old, the developmental quotient(DQ) was regularly tested by the 0-6 Years Old Pediatric Examination Table of Neuropsychological Development(pediatric neuropsychological table for short).The neurodevelopmental outcomes of these children were confirmed by clinical diagnosis and follow-up evaluations after 12 months old.Then early intervention was performed in children with abnormal results.The self-control study was designed to observe the clinical effect, and the correlation between the two evaluation results and the related factors of early neuromotor development abnormality were analyzed. Results 1) In terms of neurological developmental outcomes, there were 59(36.8%) cases of normal development, 58(36.3%) cases of developmental deviation,32(20%) cases of developmental delay, and 11(6.9%) cases of cerebral palsy.2)The GMs evaluation result of the writhing movements stage before and after the early intervention was significantly different(χ~2=35.367, P<0.01).3) Children′s DQ after intervention was significantly higher than that before intervention(t=-4.593, P<0.01).4) GMs assessment results was significantly related to the score of Pediatric Neuropsychological Scale(P<0.05 or<0.01).5) Logistic regression analysis showed that the high risk factors of abnormal evaluation result in the twisting stage included low birth weight(OR=7.650,95%CI:1.129-51.813,P=0.037), hypoxic ischemicen cephalopatly(OR=2.656,95%CI:1.158-6.089,P=0.021), brain injury(OR=2.123,95%CI:1.017-4.434,P=0.045) and premature birth(OR=2.405,95%CI:1.126-5.133,P=0.023). Conclusion Combination of GMs assessment and Pediatric Neuropsychological Scale is helpful to predict the neurological development outcomes of high-risk infants, which plays a guiding role in early intervention of high-risk infants.