Dubowitz评估联合振幅整合脑电图诊断早产儿脑损伤的价值

目的探讨Dubowitz评估联合振幅整合脑电图诊断早产儿脑损伤的价值。方法选取2019年1月—2021年12月郑州市妇幼保健院接诊的160例存在脑损伤高危因素的早产儿作为研究对象,根据是否发生脑损伤分为脑损伤组(89例)和非脑损伤组(71例)。所有早产儿均进行Dubowitz评估、振幅整合脑电图和头颅MRI检查;比较2组早产儿Dubowitz评分、振幅整合脑电图各参数评分及监测结果,使用受试者工作特征曲线(ROC)分析Dubowitz评估和振幅整合脑电图对早产儿脑损伤的诊断效能,比较Dubowitz评估联合振幅整合脑电图与头颅MRI检查诊断早产儿脑损伤的灵敏度、特异度。结果脑损伤组早产儿Dubowitz评估中的姿势与肌张力、肌张力模式、反射、运动、异常体征、定向力和行为6个维度评分及总评分均低于非脑损伤组,差异均有统计学意义(P<0.05)。脑损伤组早产儿振幅整合脑电图中连续性、睡眠-觉醒周期、下边界振幅、宽带评分及总评分均低于非脑损伤组,差异均有统计学意义(P<0.05)。脑损伤组早产儿振幅整合脑电图中正常或轻度异常比例低于非脑损伤组,中度异常及重度异常比例均高于非脑损伤组,差异有统计学意义(Z=-9.267,P<0.05)。ROC曲线分析结果显示,Dubowitz评分、振幅整合脑电图评分诊断早产儿脑损伤的AUC值分别为0.631、0.666(均P<0.05),二者联合诊断的AUC值为0.790(P<0.001)。Dubowitz评估联合振幅整合脑电图、头颅MRI检查诊断早产儿脑损伤的灵敏度分别为89.89%(80/89)、92.13%(82/89),特异度分别为88.73%(63/71)、91.55%(65/71),差异均无统计学意义(χ2=0.275、0.317,均P>0.05)。结论Dubowitz评估联合振幅整合脑电图早期诊断早产儿脑损伤的价值较好,具有较高的诊断效能,值得临床应用。

Dubowitz评分评价新生儿窒息预后的价值

对新生儿窒息216例进行Dubowitz神经系评分,以新生儿窒息病死例数、颅内出血及新生儿缺血缺氧性脑病发生例数、3岁时出现神经系统后遗症例数作为新生儿窒息严重程度及预后的指标。结果Dubowitz神经系评分分值与新生儿病死例数等四项指标具有明显相关性,并且不同分值区间上述四项指标的发生例数具有统计学意义。认为Dubowitz神经系评分对于新生儿窒息严重程度及预后的判断具有十分重要的价值。

Assessing gestational age of babies: Performance of obstetric ultrasound scan compared to that from the combination of Naegle’s rule and Dubowitz score in the 21st century

Background: Some researchers have suggested that when Naegle’s rule (NR) and Dubowitz score (DS) are combined, it could out-perform obstetric ultrasound scan (USS). Others still believe that obstetric USS alone is still effective relative to the combination of NR rule and DS in assessing the gestational age (GA) of babies. Objectives: To determine and compare the GA of babies using obstetric USS, NR and DS;and to provide relevant public health information on obstetric USS in the 21st century. Methods: Subjects were selected using systematic random sampling and the GA of babies was determined using obstetric USS, NR, and DS. Statistical package for social science (SPSS) statistical software version 16, Illinois, Chicago USA was used for all data analysis. Results: Eightyfive mother-baby pairs were studied. Forty-four babies (52%) were males and 41 (48%) females. Sixty four (75%) were term with a mean (SD) BW of 3.02 (0.59) at 95%CI (2.89 -?3.14) kg. The overall mean GA of the babies was 38.49 (2.89) at 95%CI (38.14 -?38.85) weeks. The mean GA using obstetric USS, NR and DS were 38.52 (1.98) at 95%CI (38.14 -?38.99), 38.09 (4.13) at 95%CI (37.20-?38.99) and 38.82 (2.02) at 95%CI (38.39 -?39.26), but comparison of these means was not significant (p = 0.256). Combined mean GA by NR and DS was 38.46 (3.26) at 95%CI (37.96 -?38.95). Comparing this mean with mean GA obtained by obstetric USS was also not significant (p = 0.885). Conclusion: The GA assessments by Obstetric USS, NR and DS were all reliable, and Obstetric USS performed effectively relative to combined NR and DS.

Dubowitz综合征一例

患儿女，4岁2个月，因全身皮肤红斑，丘疹，毛发稀少及头面部畸形就诊.患儿生后40天时全身出现片状红斑、丘疹，以后皮疹逐渐增多，伴瘙痒,出汗正常.足月出生，出生时头偏小，眼小，毛发稀少．并有肛门闭锁．体质量2．4kg，Apgar评分10分，母乳喂养．出生以来较同龄儿童发育筹，智力发育迟缓.在多家医院皮肤科、儿科就诊，拟诊湿疹，

全身运动质量评估联合Dubowitz神经学检查在窒息早产儿神经发育评估中的应用

目的分析全身运动质量评估(GMs)联合Dubowitz神经学检查在窒息早产儿神经发育评估中的应用价值。方法选取2017年2月-2018年3月在南通大学附属医院新生儿病房治疗的60例窒息早产儿为研究对象,根据2012年早产儿脑损伤专家共识将研究对象分为脑损伤组(n=28)、非脑损伤组(n=32),分别于生后7 d内(至少2次)、纠正胎龄满40周行Dubowitz神经学检查,在足月前阶段、扭动运动阶段以及不安运动阶段行GMs的初筛和复筛,在纠正胎龄3个月、6个月及12个月时行婴幼儿智能发育量表测定(CDCC)。分析GMs联合Dubowitz神经学检查在窒息早产儿脑损伤中的早期诊断价值及与CDCC的相关性。结果1)GMs联合Dubowitz神经学检查预测窒息早产儿脑损伤的灵敏度为96.43%,特异度为84.38%。2)GMs联合Dubowitz对早产儿脑损伤的筛查阳性率与纠正胎龄满3个月、6个月、12个月时CDCC(PDI、MDI)评分均具有正相关性(r=0.71、0.66;0.67、0.59;0.73、0.71),其中与12个月CDCC相关性最强。结论GMs联合Dubowitz神经学检查可作为窒息早产儿脑损伤早期诊断的有效手段。

晚期早产儿Dubowitz神经学评估法与发育行为结局的关联性研究

目的初步评价Dubowitz神经学评估法-第2版(The Neurological Assessment of the Preterm and Fullterm Newborn Infant-Second Edition)对晚期早产儿发育行为结局的预测效果,为完善晚期早产儿随访体系提供线索。方法选取2016年10月-2017年3月间在上海市第一妇婴保健院出生的低风险晚期早产儿(34+0~36+6孕周)116例组成随访队列,于超早期(生后6h内)和矫正"足月"(矫正胎龄40孕周)时分别进行Dubowitz神经学评估,矫正6月龄时进行贝利-Ⅲ诊断测试(Bayley Scale of Infant and Toddler Development-3rd Edition),采用Pearson相关系数分析Dubowitz神经学评估分数与认知、运动发育商之间的相关性。结果矫正6月龄时,认知发育商与超早期和矫正"足月"异常体征分数相关(r=0.184和-0.187,P均<0.05),与矫正"足月"姿势和肌张力、反射两个维度分数相关(r=0.187和0.182,P均<0.05);运动发育商与超早期姿势和肌张力、异常体征两个维度相关(r=0.201和0.219,P均<0.05)。结论 Dubowitz神经学评估对晚期早产儿的发育行为结局具有一定的预测价值,值得在更大的人群中进一步研究和应用。