Chen Catherine, Friedman Sandra, Butler Samantha, Jeruss Stefanie, Terrin Norma, Tighiouart Hocine, Ware Janice, Wilson Jay M, Parsons Susan K
Department of Surgery, Children's Hospital, Boston, MA 02115, USA.
J Pediatr Surg. 2007 Jun;42(6):1052-6; discussion 1056. doi: 10.1016/j.jpedsurg.2007.01.042.
Infants with congenital diaphragmatic hernia require complex surgical care and may have neurodevelopmental morbidity. We examined the performance of reports of motor functioning in 25 congenital diaphragmatic hernia survivors using the parent-completed Developmental Profile-II and a clinical evaluation by a neurodevelopmental pediatrician (MD) measured against the Bayley motor scale.
Bayley motor scores were dichotomized as normal or abnormal. Sensitivity and specificity were calculated for each test.
The median age at assessment was 25 months. Bayley motor scores were abnormal in 77% of infants tested (10/13). The MD examinations detected motor problems in 92% (12/13). Sensitivity and specificity of the MD examination were 1.0 and 0.33, respectively. Developmental Profile-II physical scores were abnormal in 15% (2/13); sensitivity and specificity were 0.2 and 1.0, respectively.
The high rate of abnormal motor findings in this study supports the need for ongoing screening and evaluation. The sensitivity of MD examinations was excellent, but hypotonia findings were not universally corroborated by the Bayley. Although specificity of parent-reported motor findings was high, parents underreported abnormal motor findings. Parental reports of neurodevelopmental problems should be heeded, and physicians should perform screening motor examinations. Bayley assessments may be warranted to determine the functional implications of observed abnormalities.
先天性膈疝患儿需要复杂的手术治疗，且可能存在神经发育方面的疾病。我们使用家长填写的《发育概况-II》以及神经发育儿科医生（医学博士）依据贝利运动量表进行的临床评估，对25名先天性膈疝幸存者的运动功能报告表现进行了研究。
将贝利运动评分分为正常或异常两类。计算每项测试的敏感性和特异性。
评估时的中位年龄为25个月。接受测试的婴儿中，77%（10/13）的贝利运动评分异常。医学博士的检查发现92%（12/13）的婴儿存在运动问题。医学博士检查的敏感性和特异性分别为1.0和0.33。《发育概况-II》的身体评分中，15%（2/13）异常；敏感性和特异性分别为0.2和1.0。
本研究中运动异常发现的高发生率支持持续进行筛查和评估的必要性。医学博士检查的敏感性极佳，但低张力发现并非都得到贝利量表的证实。虽然家长报告的运动发现特异性较高，但家长对异常运动发现的报告不足。应重视家长关于神经发育问题的报告，医生应进行运动筛查检查。可能需要进行贝利评估以确定观察到的异常的功能影响。
