Section of Pediatric Surgery, Department of Surgery.
Section of Neonatology, Department of Pediatrics.
J Pediatr Gastroenterol Nutr. 2021 Apr 1;72(4):592-596. doi: 10.1097/MPG.0000000000003021.
The aim of the study was to assess the neurological status in infants with biliary atresia (BA) at time of diagnosis, using Prechtl's validated General Movement Assessment.
Infants diagnosed with BA were prospectively included in a nationwide cohort study. From birth to approximately 46 weeks of postmenstrual age (PMA), general movements (GMs) are defined as "writhing movements." At 46 to 49 weeks PMA, "'fidgety movements" emerge. The infant's early motor repertoire was recorded on video before Kasai portoenterostomy. We scored GM optimality scores (min-max 5-42) or motor optimality scores (MOS, min-max 5-28) as appropriate. We defined GM optimality scores <36 and MOS <26 as atypical, and compared the results with 2 reference groups of healthy peers.
We assessed GMs in 35 infants with BA (11/35 boys, gestational age 40 weeks [36-42], birth weight 3370 g [2015-4285]). At time of diagnosis (PMA 47 weeks [42-60]), 16 infants (46%) showed atypical GMs. The proportion of infants with atypical GMs was significantly higher in BA (46%) than in 2 reference groups of healthy infants (vs 10%, P < 0.001; vs 18%, P < 0.001). Total and direct bilirubin levels were 165 μmol/L (87-364) and 134 μmol/L (72-334), respectively, height z score was 0.05 (-2.90, 1.75), weight z score -0.52 ([-2.50, -0.20) and mean upper arm circumference z score -1.80 (-2.50, -0.20). We found no statistically significant relation between atypical GMs and clinical variables.
Almost half of the infants with BA showed atypical GMs at time of diagnosis, suggesting neurological impairment. Close monitoring of these infants is warranted to determine their individual neurodevelopmental trajectories.
本研究旨在使用 Prechtl 经过验证的一般性运动评估来评估胆道闭锁（BA）婴儿在诊断时的神经状态。
本研究前瞻性纳入了一项全国性队列研究中的 BA 确诊婴儿。从出生到大约 46 周的校正胎龄（PMA），一般运动（GMs）被定义为“扭动运动”。在 46 至 49 周的 PMA 期间，出现“不安运动”。在 Kasai 门腔分流术前，通过视频记录婴儿的早期运动模式。我们对 GMs 进行了适当的优化评分（最小值-最大值 5-42）或运动优化评分（MOS，最小值-最大值 5-28）。我们将 GMs 优化评分<36 和 MOS<26 定义为异常，并将结果与 2 个健康对照组进行比较。
我们评估了 35 名 BA 婴儿的 GMs（11/35 名男孩，胎龄 40 周[36-42]，出生体重 3370 g[2015-4285]）。在诊断时（PMA 47 周[42-60]），16 名婴儿（46%）出现了异常 GMs。BA 组中异常 GMs 的婴儿比例明显高于 2 个健康婴儿对照组（分别为 46%比 10%，P<0.001；46%比 18%，P<0.001）。总胆红素和直接胆红素水平分别为 165 μmol/L（87-364）和 134 μmol/L（72-334），身高 z 评分 0.05（-2.90，1.75），体重 z 评分-0.52（-2.50，-0.20）和平均上臂周长 z 评分-1.80（-2.50，-0.20）。我们没有发现异常 GMs 与临床变量之间存在统计学显著关系。
几乎一半的 BA 婴儿在诊断时出现异常 GMs，提示存在神经损伤。需要对这些婴儿进行密切监测，以确定其个体神经发育轨迹。
