4至6岁围产期高危新生儿的行为结局，包括注意力缺陷多动障碍/多动障碍和轻微神经体征与风险因素的关系。

Behavioral outcome including attention deficit hyperactivity disorder/hyperactivity disorder and minor neurological signs in perinatal high-risk newborns at 4-6 years of age with relation to risk factors.

作者信息

Sato Masuko, Aotani Hirofumi, Hattori Ritsuko, Funato Masahisa

机构信息

Department of Pedology, Kyoto Women's University, Kyoto, Japan.

出版信息

Pediatr Int. 2004 Jun;46(3):346-52. doi: 10.1111/j.1442-200x.2004.01883.x.

DOI:10.1111/j.1442-200x.2004.01883.x

PMID:15151555

Abstract

BACKGROUND

Diagnostic problems with the criteria of attention deficit hyperactivity disorder (ADHD) in the Diagnostic Statistical Manual, 4th edn, have been identified. The aim of this study was to clarify whether the minor neurological signs test (MNT) the authors had previously reported was a predictor for the criteria of ADHD or hyperactivity disorder (HD) in perinatal risk children at 4-6 years of age and what kind of risk factors related to MNT.

METHODS

A total of 136 children discharged from neonatal intensive care units were examined at the age of 4-6 years by a developmental neuropediatrician using both MNT and diagnostic criteria of DSM-IV ADHD/ICD-10 (International Classification of Diseases, 10th edn) HD. SPSS base and professional were used for statistical analysis.

RESULTS

On comparison of diagnostic criteria between ADHD (11.0%) and HD (27.5%), the incidence in the same subjects showed significant difference. MNT scores showed significant correlation with criteria of ADHD (P < 0.01) and HD (P < 0.05). Diagnostic validity of MNT for predicting ADHD was demonstrated with 78% sensitivity and 79% specificity. High positive rates on MNT did not show a significant difference between the very low birthweight (VLBW) and non-low birthweight (NLBW) groups. Behavioral outcome with relation to risk factors were analyzed using multiple regression analysis. Apgar 5 in the NLBW group and toxemia of pregnancy and small for gestational age (SGA) in VLBW group were highly correlated with behavioral outcome.

CONCLUSIONS

Minor neurological signs test score was a significant predictor for criteria of ADHD and HD. High incidences of positive MNT were suspected in not only VLBW children but also NLBW children and Apgar 5 in NLBW children and toxemia of pregnancy and SGA in VLBW children influenced behavioral outcome.

摘要

背景

已发现《精神疾病诊断与统计手册》第4版中注意力缺陷多动障碍（ADHD）的诊断标准存在问题。本研究的目的是明确作者之前报告的轻微神经体征测试（MNT）是否可作为4至6岁围产期风险儿童ADHD或多动障碍（HD）标准的预测指标，以及与MNT相关的风险因素类型。

方法

共有136名从新生儿重症监护病房出院的儿童在4至6岁时由发育神经儿科医生使用MNT以及DSM-IV ADHD/ICD-10（《国际疾病分类》第10版）HD的诊断标准进行检查。使用SPSS基础版和专业版进行统计分析。

结果

比较ADHD（11.0%）和HD（27.5%）的诊断标准时，同一受试者中的发病率显示出显著差异。MNT评分与ADHD标准（P < 0.01）和HD标准（P < 0.05）显示出显著相关性。MNT预测ADHD的诊断有效性通过78%的敏感性和79%的特异性得到证实。极低出生体重（VLBW）组和非低出生体重（NLBW）组在MNT上的高阳性率没有显著差异。使用多元回归分析分析与风险因素相关的行为结果。NLBW组的出生后5分钟阿氏评分以及VLBW组的妊娠中毒症和小于胎龄（SGA）与行为结果高度相关。