晚期早产儿Dubowitz神经学评估法与发育行为结局的关联性研究

目的 初步评价Dubowitz神经学评估法-第2版(The Neurological Assessment of the Preterm and Full-term Newborn Infant-Second Edition)对晚期早产儿发育行为结局的预测效果,为完善晚期早产儿随访体系提供线索。方法 选取2016年10月-2017年3月间在上海市第一妇婴保健院出生的低风险晚期早产儿(34⁺⁰~36⁺⁶孕周)116例组成随访队列,于超早期(生后6 h内)和矫正“足月”(矫正胎龄40孕周)时分别进行Dubowitz神经学评估,矫正6月龄时进行贝利-Ⅲ诊断测试(Bayley Scale of Infant and Toddler Development-3rd Edition),采用Pearson相关系数分析Dubowitz神经学评估分数与认知、运动发育商之间的相关性。结果 矫正6月龄时,认知发育商与超早期和矫正“足月”异常体征分数相关(r=0.184和-0.187,P均＜0.05),与矫正“足月”姿势和肌张力、反射两个维度分数相关(r=0.187和0.182,P均＜0.05);运动发育商与超早期姿势和肌张力、异常体征两个维度相关(r=0.201和0.219,P均＜0.05)。结论 Dubowitz神经学评估对晚期早产儿的发育行为结局具有一定的预测价值,值得在更大的人群中进一步研究和应用。

Research on the association between Dubowitz neurological assessment and the outcome of developmental behavior in late-preterm infants

Objective To preliminarily examine the predictive validity of the Dubowitz Neurological Assessment-2nd Edition (The Neurological Assessment of the Preterm and Full-term Newborn Infant-second edition) to the outcome of developmental behavior in late-preterm infants,in order to provide basis for improving the follow-up system of late-preterm infants. Methods A total of 116 low-risk late-preterm (34⁺⁰~36⁺⁶ gestational weeks) infants born in Shanghai First Maternity and Infant Hospital from October 2016 to March 2017 were selected into the follow-up cohort.Dubowitz Neurological Assessment was performed at ultra-early stage (within 6 hours after birth) and at term age (40-week corrected gestational age) respectively.Bayley-Ⅲ (Bayley Scale of Infant Development-3rd Edition) was used to assess developmental outcome at corrected age 6 months .Pearson correlation coefficients were used to analyze the correlation between Dubowitz Neurological Assessment scores and Bayley-Ⅲ cognitive and motor composite scores. Results The cognitive composite scores of corrected age of 6 months were associated with abnormal signs of both ultra-early stage (r=0.184, P＜0.05) and term age (r=-0.187, P＜0.05),and were related to the scores of posture and tone and reflex(r=0.187,0.182,P＜0.05).The motor composite scores were related to posture and tone and abnormal signs (r=0.201,0.219,P＜0.05). Conclusion The Dubowitz Neurological Assessment has a certain predictive value for the outcome of developmental behavior of late-preterm infants, and further study is warranted for the application in a larger population.