早产儿扭动运动阶段全身运动质量评估与头颅MRI检查对早产儿神经发育结局的预测价值比较

Comparison on the predictive value of general movements quality assessment and cranial MRI examination in the neurodevelopment of premature infants at writhing movement stage

目的比较早产儿扭动运动阶段全身运动(GMs)质量评估与头颅MRI检查对早产儿神经发育结局的预测价值。方法选取2020年12月至2021年12月深圳市龙华区人民医院收治的240例早产儿作为研究对象。早产儿纠正胎龄足月时进行头颅MRI检查,纠正胎龄足月后1个月内进行GMs,纠正月龄12个月时通过临床诊断与Gesell发育量表评估神经发育结局。以Gesell结果为金标准,分析早产儿扭动运动阶段GMs与头颅MRI检查的预测价值。结果GMs质量评估预测神经发育不良126例,漏诊8例,误诊81例;头颅MRI预测神经发育不良33例,漏诊29例,误诊9例。GMs质量评估的敏感度高于头颅MRI,而特异度、准确性低于头颅MRI(P<0.05)。结论在预测早产儿神经发育结局方面,早产儿扭动运动阶段GMs的敏感度高于头颅MRI检查,但特异度及准确性低于头颅MRI,在临床实际工作中应综合考虑,合理选用GMs或头颅MRI检查。

Objective To compare the predictive value of general movements(GMs)quality assessment and cranial magnetic resonance imaging(MRI)in the neurodevelopmental of preterm infants at writhing movement stage.Methods A total of 240 premature infants in People’s Hospital of Longhua,Shenzhen from December 2020 to December 2021 were selected as research subjects.Cranial MRI was performed at the gestational age correction of preterm infants,GMs quality assessment was performed within one month after the gestational age correction of preterm infants,and the neurodevelopmental outcomes were evaluated by clinical diagnosis and Gesell developmental schedules at 12 months after the gestational age correction.The results of Gesell developmental schedules were used as the gold standard,and the predictive value of GMs quality assessment and cranial MRI examination was analyzed.Results In the results of GMs quality assessment,126 cases of neurodysplasia were predicted,8 cases were missed and 81 cases were misdiagnosed.In the results of cranial MRI,33 cases of neurodysplasia were predicted,29 cases were missed and 9 cases were misdiagnosed.The sensitivity of GMs quality assessment was higher than that of cranial MRI,while the specificity and accuracy of GMs quality assessment were lower than those of cranial MRI(P<0.05).Conclusion In terms of predicting neurodevelopmental outcomes of preterm infants,the sensitivity of GMs quality assessment at writhing movement stage is higher than that of cranial MRI,but the specificity and accuracy are lower than those of cranial MRI.GMs quality assessment or cranial MRI should be considered comprehensively and reasonably selected in clinical practice.