Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Rehabilitation, Exercise, and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH.
Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH.
J Pediatr. 2021 May;232:80-86.e2. doi: 10.1016/j.jpeds.2020.12.056. Epub 2021 Jan 13.
To evaluate the prevalence and associations between structural magnetic resonance imaging (sMRI) injury/abnormality at term-equivalent age and absent fidgety General Movements Assessment (GMA) and abnormal Hammersmith Infant Neurological Examination (HINE) scores among infants born very preterm at 3-4 months of corrected age.
This prospective cohort study enrolled 392 infants born ≤2 weeks of gestation from 5 neonatal intensive care units in the greater Cincinnati area between September 2016 and October 2019. Infants completed sMRI at term-equivalent age and GMA and HINE at 3-4 months of corrected age. All assessors were blinded.
Of 392 infants, 375 (96%) had complete data. Of these, 44 (12%) exhibited moderate or severe brain abnormalities, 17 (4.5%) had abnormal GMA, and 77 (20.3%) had abnormal HINE. Global and regional abnormality scores on sMRI were significantly correlated with GMA (R range 0.05-0.17) and HINE at 3-4 months of corrected age (R range 0.01-0.17). These associations remained significant in multivariable analyses after adjusting for gestational age and sex. There was a significant but low correlation (R 0.14) between GMA and HINE.
We observed a low prevalence of moderate or severe brain abnormalities in survivors born very preterm in this geographically defined cohort. The much greater prevalence of abnormal motor examination on the HINE compared with GMA and their low correlation suggests that these tests evaluate different constructs and, thus, should be used in combination with sMRI rather than interchangeably.
评估足月龄相当龄时结构磁共振成像（sMRI）损伤/异常与非常早产儿 3-4 月龄时缺乏活跃的一般运动评估（GMA）和异常哈默史密斯婴儿神经检查（HINE）评分之间的相关性。
本前瞻性队列研究纳入了 2016 年 9 月至 2019 年 10 月在辛辛那提地区 5 家新生儿重症监护病房出生的≤2 周龄的 392 名婴儿。婴儿在足月龄相当龄时进行 sMRI 检查，在 3-4 月龄的校正年龄时进行 GMA 和 HINE 检查。所有评估者均为盲法。
在 392 名婴儿中，375 名（96%）有完整的数据。其中，44 名（12%）表现出中度或重度脑异常，17 名（4.5%）GMA 异常，77 名（20.3%）HINE 异常。sMRI 的整体和区域异常评分与 GMA（R 范围 0.05-0.17）和 3-4 月龄校正年龄时的 HINE（R 范围 0.01-0.17）显著相关。在调整胎龄和性别后，多变量分析中这些相关性仍然显著。GMA 和 HINE 之间存在显著但低度的相关性（R 0.14）。
在本地理定义队列中，我们观察到非常早产儿幸存者中中度或重度脑异常的发生率较低。HINE 上运动检查异常的发生率远高于 GMA，且相关性较低，这表明这些测试评估的是不同的结构，因此，应与 sMRI 联合使用，而不是互换使用。
