全身运动质量评估对窒息新生儿24月龄时不良结局的预测价值

Predictive value of qualitative assessment of general movements for adverse outcomes at 24 months of age in infants with asphyxia

摘要:

目的探讨全身运动(GMs)质量评估预测足月窒息新生儿24月龄时不良结局的价值。方法2009~2012年入住NICU、且出院后获得随访的114例足月窒息患儿为研究对象。生后3个月内进行GMs质量评估。出院后随访至24月龄时采用贝利婴幼儿发展量表(BSID)测试发育商。结果 GMs评估结果:扭动运动阶段为单调性全身运动的有20例(17.5%),为痉挛性同步运动的有7例(6.1%);不安运动阶段评估为不安运动缺乏的有8例(7.0%)。24月龄时发育商评估结果:有不良发育学结局共7例(6.1%),其中脑瘫伴智力发育迟滞6例,智力发育迟滞1例。GMs评估示扭动运动阶段单调性全身运动与24月龄时患儿发育结局的一致性差(Kappa=-0.019, P>0.05)。痉挛性同步运动与24月龄时患儿发育结局的一致性较高(Kappa=0.848,P<0.05),其对24月龄发育结局的预测效度为98.2%,敏感度为85.7%,特异度为99.1%,阳性预测值为85.7%,阴性预测值为99.1%。不安运动阶段不安运动缺乏与24月龄时患儿发育结局的一致性较高(Kappa=0.786,P<0.05),其对24月龄发育结局的预测效度为97.4%,敏感度为85.7%,特异度为98.1%,阳性预测值为75.0%,阴性预测值为99.1%。结论 GMs评估示痉挛性同步运动和不安运动缺乏对窒息新生儿24月龄时的不良发育结局有较好的预测价值。

Abstract:

Objective To investigate the predictive value of the qualitative assessment of general movements (GMs) for adverse outcomes at 24 months of age in full-term infants with asphyxia. Methods A total of 114 fullterm asphyxiated infants, who were admitted to the neonatal intensive care unit between 2009 and 2012 and took part in follow-ups after discharge were included in the study. All of them received the qualitative assessment of GMs within 3 months after birth. The development quotient was determined with the Bayley Scales of Infant Development at 24 months of age. Results The results of the qualitative assessment of GMs within 3 months after birth showed that among 114 infants, 20(17.5%) had poor repertoire movements and 7(6.1%) had cramped-synchronized movements during the writhing movements period; 8 infants (7.0%) had the absence of fidgety movements during the fidgety movements period. The results of development quotient at 24 months of age showed that 7 infants (6.1%) had adverse developmental outcomes:6 cases of cerebral palsy and mental retardation and 1 case of mental retardation. There was a poor consistency between poor repertoire movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=-0.019; P>0.05). There was a high consistency between cramped-synchronized movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=0.848; P<0.05), and the results of predictive values of cramped-synchronized movements were shown as follows:predictive validity 98.2%, sensitivity 85.7%, specificity 99.1%, positive predictive value 85.7%, and negative predictive value 99.1%. There was a high consistency between the absence of fidgety movements during the fidgety movements period and the developmental outcomes at 24 months of age (Kappa=0.786; P<0.05), and its predictive values were expressed as follows:predictive validity 97.4%, sensitivity 85.7%, specificity 98.1%, positive predictive value 75.0%, and negative predictive value 99.1%. Conclusions Cramped-synchronized movements and absence of fidgety movements can predict adverse developmental outcomes at 24 months of age in full-term infants with asphyxia.