Amess P, McFerran C, Khan Y, Rabe H
Department of Neonatology, Brighton and Sussex University Hospitals, Brighton, UK.
Acta Paediatr. 2009 Mar;98(3):448-53. doi: 10.1111/j.1651-2227.2008.01062.x. Epub 2008 Oct 22.
To assess the value of term neurological examination and cranial ultrasound in the early prediction of neurological outcome at 12 months corrected age in a cohort of very preterm infants.
A cohort of 102 preterm infants born at <32 weeks gestation or with a birth weight of <1500 g were assessed using the Hammersmith Term Neurological Examination. They underwent cranial ultrasound examinations according to local guidelines. The Hammersmith Infant Neurological Examination was performed at 12 months corrected age. Scores for the term examinations were compared with scores derived from healthy infants born at term and with scores from low-risk preterm infants at term equivalent age. Term neurological scores and cranial ultrasound findings were compared in the prediction of 12-month neurological outcome.
Seventy-eight (76.5%) preterm infants had suboptimal total neurological scores at term when compared to healthy infants born at term. However, most went on to have optimal neurological scores at 12 months corrected age. When our cohort was compared with low-risk preterm infants at term equivalent age only 14 (13.7%) scored outside the normal range. Neither system of scoring predicted neurological outcome at 12 months corrected age as reliably as cranial ultrasound (sensitivity 0.83, specificity 0.87).
Neurological examination of preterm babies at term may be unreliable in the prediction of neurological outcome at 12 months corrected age. For early prediction of neurological outcome cranial ultrasound examination was found to be more reliable.
评估足月神经学检查和头颅超声对一组极早产儿在矫正年龄12个月时神经学预后的早期预测价值。
对102例孕周<32周或出生体重<1500g的早产儿采用哈默史密斯足月神经学检查进行评估。他们根据当地指南接受头颅超声检查。在矫正年龄12个月时进行哈默史密斯婴儿神经学检查。将足月检查的分数与足月出生的健康婴儿的分数以及足月等效年龄的低风险早产儿的分数进行比较。比较足月神经学评分和头颅超声检查结果对12个月神经学预后的预测情况。
与足月出生的健康婴儿相比，78例（76.5%）早产儿在足月时的总神经学评分不理想。然而，大多数婴儿在矫正年龄12个月时神经学评分达到理想水平。当将我们的队列与足月等效年龄的低风险早产儿进行比较时，只有14例（13.7%）的评分超出正常范围。两种评分系统对矫正年龄12个月时神经学预后的预测都不如头颅超声可靠（敏感性0.83，特异性0.87）。
对早产儿进行足月神经学检查在预测矫正年龄12个月时的神经学预后方面可能不可靠。对于神经学预后的早期预测，发现头颅超声检查更可靠。
