Victorian Infant Brain Study, Murdoch Childrens Research Institute, Melbourne, Australia.
Pediatrics. 2013 Aug;132(2):e452-8. doi: 10.1542/peds.2013-0177. Epub 2013 Jul 22.
Although ~50% of very preterm (VP) children have neurodevelopmental impairments, early prediction of infants who will experience problems later in life remains a challenge. This study evaluated the predictive value of general movements (GM; spontaneous and endogenous movements) at 1 and 3 months' corrected age for neurodevelopment at 2 and 4 years of age in VP children.
At 1 and 3 months' corrected age, infants born <30 weeks' gestation had GM assessed as normal or abnormal. Motor, cognitive, and language development at 2 years was assessed by using the Bayley Scales of Infant and Toddler Development, Third Edition. At 4 years, cognitive and language outcomes were assessed by using the Differential Ability Scale-Second Edition and motor outcomes with the Movement Assessment Battery for Children-Second Edition; a diagnosis of cerebral palsy was documented.
Ninety-nine VP infants were recruited, with 97% and 88% of survivors followed up at age 2 and 4 years, respectively. Abnormal GM at 1 month were associated with worse motor outcomes at 2 and 4 years but not language or cognitive outcomes. Abnormal GM at 3 months were associated with worse motor, cognitive, and language outcomes at both 2 and 4 years. Overall, GM at 1 month demonstrated better sensitivity to impairments at 2 and 4 years, whereas GM at 3 months had better specificity and were more accurate overall at distinguishing between children with and without impairment.
Abnormal GM in VP infants, particularly at 3 months postterm, are predictive of worse neurodevelopment at ages 2 and 4 years.
尽管约有 50%的极早产儿（VP）存在神经发育障碍，但对于哪些婴儿在以后的生活中会出现问题，早期预测仍然是一个挑战。本研究评估了 VP 婴儿在 1 个月和 3 个月校正年龄时的一般运动（GM；自发性和内源性运动）对 2 岁和 4 岁时神经发育的预测价值。
在 1 个月和 3 个月的校正年龄时，对胎龄<30 周的婴儿进行 GM 评估，判断其是否正常或异常。采用贝利婴幼儿发育量表第三版评估婴儿 2 岁时的运动、认知和语言发育情况。在 4 岁时，采用差异能力量表第二版评估认知和语言结果，采用儿童运动评估电池第二版评估运动结果；并记录脑瘫的诊断。
共招募了 99 名 VP 婴儿，其中 97%和 88%的幸存者分别在 2 岁和 4 岁时完成了随访。1 个月时 GM 异常与 2 岁和 4 岁时的运动结果较差相关，但与语言或认知结果无关。3 个月时 GM 异常与 2 岁和 4 岁时的运动、认知和语言结果较差相关。总体而言，1 个月时 GM 对 2 岁和 4 岁时的损伤具有更好的敏感性，而 3 个月时 GM 具有更好的特异性，并且在区分有无损伤的儿童方面更为准确。
VP 婴儿的 GM 异常，特别是在纠正胎龄 3 个月时，预测其在 2 岁和 4 岁时神经发育较差。
