John Hima B, Oommen Samuel P, Swathi T O, Kumar Manish, Stoen Ragnhild, Adde Lars
Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India.
Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India. Correspondence to: Dr Samuel P Oommen, Professor, Developmental Pediatrics Unit, Department of Pediatrics, Christian Medical College, Vellore 632 004, Tamil Nadu.
Indian Pediatr. 2022 Oct 15;59(10):769-773. Epub 2022 Aug 10.
A neurological assessment before discharge from the NICU would enable early targeted intervention to mitigate the risk and severity of cerebral palsy (CP) and neurodevelop-mental disability.
To assess the accuracy of general movements (GM) in the preterm and fidgety movement periods in predicting neurodevelopmental disability and cerebral palsy in very preterm infants (≤32 weeks gestational age) at 18-24 months corrected gestational age.
Prospective cohort study.
One hundred and seventy very preterm infants, mean (SD) gestation 29.8 (1.32) weeks, and birthweight 1215 (226) g.
Infants underwent GM assessments in the preterm period (31-36 weeks post-conception age) and fidgety movement period (8-18 weeks post term age). Neurodevelop-mental outcomes were assessed in 127 children using the Griffiths Mental Developmental Scales-2.
Nine children had neurodevelopmental disability (two infants with cerebral palsy and seven with global developmental delay. The relative risk (95% CI) for neurodevelopmental disability was 1.46 (0.31-6.89) with preterm movements and 6.07 (0.97 - 38.05) with fidgety movements. Sensitivity and specificity values for the prediction of neurodevelopmental disability were 33% and 64% in the preterm period and 25% and 92% in the fidgety movement period, respectively. The sensitivity and specificity values for prediction of CP were 50% and 63% in the preterm period and 100% and 93% in the fidgety movement period, respectively.
Preterm movements showed lower sensitivity and specificity than fidgety movements in predicting later CP and neurodevelopmental disability in preterm infants.
在新生儿重症监护病房（NICU）出院前进行神经学评估，将有助于早期进行有针对性的干预，以降低脑瘫（CP）和神经发育障碍的风险及严重程度。
评估早产期和不安运动期的一般运动（GM）对孕龄≤32周的极早产儿在矫正胎龄18 - 24个月时神经发育障碍和脑瘫的预测准确性。
前瞻性队列研究。
170名极早产儿，平均（标准差）孕龄29.8（1.32）周，出生体重1215（226）克。
婴儿在早产期（孕龄31 - 36周）和不安运动期（足月后8 - 18周）接受GM评估。使用格里菲斯心理发育量表 - 2对127名儿童的神经发育结局进行评估。
9名儿童有神经发育障碍（2名婴儿患有脑瘫，7名患有全面发育迟缓）。早产期运动时神经发育障碍的相对风险（95%可信区间）为1.46（0.31 - 6.89），不安运动期为6.07（0.97 - 38.95）。早产期预测神经发育障碍的敏感性和特异性值分别为33%和64%，不安运动期分别为25%和92%。早产期预测CP的敏感性和特异性值分别为50%和63%，不安运动期分别为100%和93%。
在预测早产儿后期的CP和神经发育障碍方面，早产期运动的敏感性和特异性低于不安运动期。
