Su Yu-Han, Jeng Suh-Fang, Hsieh Wu-Shiun, Tu Yu-Kang, Wu Yen-Tzu, Chen Li-Chiou
Phys Ther. 2017 Mar 1;97(3):365-373. doi: 10.1093/ptj/pzx007.
Early identification of motor dysfunction in preterm infants with very low birth weight (VLBW) is important in order to provide early intervention.
This study was to examine the motor trajectories of preterm infants with VLBW during their first year of life and to investigate the predictive ability and influencing factors of the trajectories.
A total of 342 preterm infants with VLBW were prospectively assessed for motor development by the Alberta Infant Motor Scales at 4, 6, 9, and 12 months and for developmental outcomes using the Bayley Scales of Infant and Toddler Development, second edition, at 24 months. Perinatal and socio-environmental factors were collected at baseline. Growth mixture modeling was used to explore the patterns of infants' motor trajectories during their first year of life. Logistic regression analyses were applied to examine the influencing factors associated with motor trajectories and their predictability of 24-month developmental outcomes.
Preterm infants with VLBW showed 3 distinct motor trajectories: stably normal (55%), deteriorating (32%), and persistently delayed (13%). Furthermore, the motor trajectories were predictive of 24-month cognitive and motor outcomes. Perinatal factors including lower birth weight, male gender, moderate to severe bronchopulmonary dysplasia, stage III to IV retinopathy of prematurity, and major brain damage were associated with a risk of deteriorating and persistently delayed trajectories (all P < .05). Socio-environmental factors had no association with motor trajectories.
The small sample size of the infants with a persistently delayed trajectory may have limited the assessment of some influencing factors.
The identified early motor trajectories, predictive values, and influencing factors provide insightful implications for early detection and prevention of motor -disorders in preterm infants with VLBW.
为了提供早期干预，尽早识别极低出生体重（VLBW）早产儿的运动功能障碍很重要。
本研究旨在考察VLBW早产儿出生后第一年的运动轨迹，并探究这些轨迹的预测能力及影响因素。
前瞻性评估了总共342名VLBW早产儿，在其4、6、9和12个月时通过艾伯塔婴儿运动量表评估运动发育情况，并在24个月时使用贝利婴幼儿发展量表第二版评估发育结局。在基线时收集围产期和社会环境因素。采用生长混合模型探索婴儿出生后第一年的运动轨迹模式。应用逻辑回归分析来检验与运动轨迹相关的影响因素及其对24个月发育结局的预测性。
VLBW早产儿呈现出3种不同的运动轨迹：持续正常（55%）、恶化（32%）和持续延迟（13%）。此外，运动轨迹可预测24个月时的认知和运动结局。包括较低出生体重、男性、中度至重度支气管肺发育不良、III至IV期早产儿视网膜病变以及严重脑损伤在内的围产期因素与恶化和持续延迟轨迹的风险相关（所有P <.05）。社会环境因素与运动轨迹无关。
持续延迟轨迹的婴儿样本量较小，可能限制了对一些影响因素的评估。
所确定的早期运动轨迹、预测价值和影响因素为早期发现和预防VLBW早产儿的运动障碍提供了深刻见解。
