全身运动扭动阶段评估对重度黄疸患儿运动发育结局的预测价值  

The predictive value of writhing stage general movement assessment for motor development outcomes in infants with severe neonatal jaundice

作　　者：吴州丽[1] 谭宁[1] 谢月娥[1] 史廷娇 曹爱平 谭若锟[1] 费淑兰[1] Wu Zhouli;Tan Ning;Xie Yuee;Shi Tingjiao;Cao Aiping;Tan Ruokun;Fei Shulan(Department of Neonatology, Chenzhou NO.1 People′s Hospital, Chenzhou 423000, China;Department of Child Rehabilitation, Chenzhou NO.1 People′s Hospital, Chenzhou 423000, China)

机构地区：[1]湖南省郴州市第一人民医院新生儿科,423000 [2]湖南省郴州市第一人民医院儿童康复科,423000

出　　处：《中华新生儿科杂志（中英文）》2019年第3期187-191,共5页Chinese Journal of Neonatology

基　　金：湖南省郴州市科技局资助课题(czkj2016061);湖南省卫生计生委科研计划课题项目(B20180259)。

摘　　要：目的探讨全身运动(general movements,GMs)扭动阶段评估对重度黄疸患儿运动发育结局的预测价值。方法选取2012年6月至2017年6月在郴州市第一人民医院新生儿科诊治并在儿童康复科随访至1周岁的重度黄疸患儿为研究对象。入选患儿均在校正胎龄37~48周、经治疗胆红素值降至光疗干预值以下且生命体征平稳时进行GMs扭动阶段整体评估及细化评估,并根据患儿1周岁时随访结局评价GMs扭动阶段评估对患儿运动发育结局的预测价值。结果研究期间共收治重度黄疸且满足纳入标准的患儿241例,其中男153例,女88例;胎龄(37.9±1.8)周;出生体重(3 057±480)g;血清胆红素峰值(458.9±119.1)μmol/L;GMs扭动阶段整体评估正常15例(6.2%),异常226例(93.8%),其中单调性异常217例(90.0%),痉挛同步性异常9例(3.7%)。GMs扭动阶段整体评估为GMs异常预测患儿异常运动发育结局的敏感度为100%、特异度为7.6%、阴性预测值为100%,痉挛同步性异常预测脑性瘫痪的敏感度为22.2%、特异度为97.8%、阴性预测值为94.0%;细化评估中13项对脑性瘫痪预测有意义(P<0.05),18项对异常运动发育预测有意义(P<0.05)。结论GMs扭动阶段痉挛同步性异常及细化评估与重度黄疸患儿1周岁时的运动发育结局具有相关性。Objective To study the predictive values of the general movements (GMs) assessment in writhing stage for motor development outcomes in infants with severe neonatal jaundice. Method From December of 2012 to December of 2017, infants with severe neonatal jaundice (serum bilirubin reaching the corresponding level of exchange transfusion according to the reference nomogram) in our hospital were enrolled in the study. Inclusion criteria included corrected gestational age of 37 to 48 weeks, serum bilirubin level below phototherapy intervention value after treatment and general and detailed assessment were carried out in writhing stage when the infant was stable. The patients were regularly followed-up until one-year-old to evaluate the predictive values. Result A total of 241 patients with severe neonatal jaundice were enrolled in the study, including 153 males (63.5%) and 88 females (36.5%), with gestational age between 35 and 42 weeks. The mean gestational age was (37.9±1.8) weeks, the average birth weight was (3 057±480) g, and the mean serum bilirubin value was (458.9±119.1)μmol/L. The general evaluation of the GMs was normal in 15 cases (6.2%), and abnormal in 226 cases (93.8%) with 217 cases (90.0%) were poor repertoire (PR) and 9 cases (3.7%) were cramped-synchronized (CS). The predictive values of abnormal GMs for abnormal motor development outcomes were as following: sensitivity 100%, specificity 7.6%, negative predictive value(NPV) 100%. The predictive values of CS for cerebral palsy were as following: sensitivity 22.2%, specificity 97.8%, NPV 94.0%. Detailed evaluation of 241 subjects showed that 13 items had statistically significant differences in the prediction of cerebral palsy (P<0.05), and 18 items in the prediction of abnormal motor development (P<0.05). Conclusion The CS pattern and detailed assessment of GMs in the writhing stage may be correlated with the outcomes of motor development in infants with severe neonatal jaundice until one-year-old.

关 键 词：高胆红素血症 新生儿 核黄疸 全身运动评估 发育结局 

分 类 号：R722.17[医药卫生—儿科]