婴儿心理发育及运动发育的影响因素

婴儿心理发育及运动发育的影响因素西安医科大学第一医学院妇幼系（７１００６１）于学文，罗国刚，孙晓勉，崔丽侠现代生物医学模式正在逐渐向生物一心理一社会医学模式转化，人们既要悉知儿童心理发育及行为现状，又要检出和干预发育及行为障碍者．对幼儿及学龄前儿意的...     

Williams综合征儿童早期运动发育特征

目的 分析Williams综合征(Williams syndrome,WS)儿童的早期运动发育情况,为临床早期干预提供依据。方法 对2018年9月至2021年8月间59例0～24月龄的WS儿童的临床资料进行回顾性分析,其中男40例,女19例。根据Peabody运动发育量表(Peabody Developmental Motor Scale Ⅱ)测试结果,分析不同年龄患儿的运动发育情况。结果 男女儿童月龄和运动商的比较差异均无统计学意义(P>0.05)。<6月龄组、6～<12月龄组、12～<18月龄组和18～24月龄组的粗大运动商分别为94±5、78±11、71±8、63±8,精细运动商分别为94±5、80±10、74±9、65±9,粗大运动商和精细运动商随着月龄增长逐渐下降(P<0.05)。<6月龄组、6～<12月龄组、12～<18月龄组和18～24月龄组的粗大运动发育异常率分别为0%、53%、87%、93%,精细运动发育异常率分别为0%、47%、67%、93%,粗大运动和精细运动发育异常率均随月龄增长而上升(P<0.05)。结论 ...     

Peabody运动发育量表在早产儿神经发育障碍评估中的应用

随着围生医学的日益发展,早产儿存活率明显提升,其早期严重并发症多有效控制,但部分存活早产儿遗留脑性瘫痪、运动发育迟缓、视听觉损害等神经发育障碍,严重影响了其生存质量.作为新生儿体格检查的一部分,Peabody运动发育量表在了解新生儿的早期智能发育情况、行为能力以及神经发育情况方面发挥越来越重要的作用.本文就Peabody运动发育量表在早产儿神经发育障碍评估中的应用进行综述.     

Alberta婴儿运动量表对新生儿重症监护室高危儿出院后筛查运动发育落后的准确性研究

目的 分析Alberta婴儿运动量表（AIMS）在NICU高危儿随访中筛查运动发育落后的应用价值，为更好解释患儿病情和尽早合理干预提供依据。方法 纳入经NICU治疗后并于2013年11月至2015年1月在上海健高儿科门诊部随访的高危儿，行AIMS和Peabody运动发育量表-第2版（PDMS-2）评估。将患儿的AIMS总分与PDMS-2的粗大运动发育商（GMQ）进行百分位数换算，分析两者的相关性。以6月龄后GMQ≥90作为运动发育正常的参考标准，绘制AIMS百分位数的ROC曲线，计算约登指数和预测界值。进而根据所得界值分析AIMS预测运动发育落后的价值。结果 70例高危儿进入分析，产生170个AIMS数据和70个6月龄PDMS-2 GMQ数据。0~3月龄的AIMS百分位数与PDMS-2的GMQ百分位数相关系数（r）为0.09（P=0.69）；≥4月龄两者的r为0.73（P＜0.001）。与参考标准比较，形成AIMS百分位数的ROC曲线，曲线下面积为0.929（95%CI:0.876~0.982），预测界值为P17.5。以AIMS百分位数＜17.5预测运动发育落后的敏感度为87.6%（95% CI:68.4％~95.4％），特异度为88.1%（95%CI:80.6％~93.1%），阳性预测值为65.0%（95%CI:48.3％~78.9％），阴性预测值为96.3%（95%CI:90.2％~98.8％）。结论 ＞3月龄的高危儿行AMIS评估对识别运动发育正常有很高的预测价值，为避免对高危儿过度诊断和干预提供依据。     

婴儿运动能力检查对早产儿运动发育异常的早期诊断价值文献回顾

目的　评估新生儿神经行为评分（neonatal behavioral neurological assessment,NBNA）与婴儿运动能力检查（the test of infant motor performance,TIMP）对早产儿运动发育异常的早期诊断价值。方法　检索Pubmed、Embase、Cochrane Library、万方、中国知网数据库,查询从建库至2017-05-20有关早产儿中使用NBNA或者TIMP进行神经行为或运动评估的文献,使用基于共识选择健康测量工具的标准清单（the consensus-based standards for selection of measurement instruments checklist,COSMIN）进行方法学质量评价,并分析NBNA与TIMP的预测效度。结果　最终获得16篇符合标准的文献,其中,5篇关于NBNA在早产儿随访中的应用研究,均存在明显威胁研究的方法学质量的因素;11篇关于TIMP在早产儿随访中的应用研究,其中9篇研究结果示TIMP对纳入早产儿半岁后的神经发育评分有良好的预测效度（灵敏度：0.50～1.00;特异度：0.68～1.00）或相关度（r：0.36～0.44）,故TIMP有助于早期诊断。结论　TIMP作为一种功能性运动的评估方法,对早产儿远期神经发育结局具有良好的预测效度。     

抚触对婴儿早期发育的影响

目前,各种研究显示抚触能够有效地促进婴儿的智力及体格发育,增强免疫功能。为探讨抚触对婴儿早期发育的影响,对200例婴儿进行随机对照研究,现将结果报告如下。1对象和方法1.1对象2006年6~8月出生的足月适胎龄婴儿200例,随机分为抚触组和对照组(未接受抚触),每组各100例,抚触组中男55例,女45例,汉族68例,维族28例,其他4例;对照组中男53例,女47例,汉族56例,维族37例,其他7例。胎龄平均为38.05周,均无早产、窒息史等,平均出生体重抚触组为3450±51g,对照组为3420±55g。母孕期内无并发症。抚触组中母乳喂养62例,混合喂养28例,人工喂养10例;对…     

低水平铅暴露对早期婴儿发育的影响

为了研究出生前后低水平铅暴露对儿童发育的影响，前瞻性观察了１０２例出生时血铅在０．１０～０．８４μｍｏｌ／Ｌ低水平铅暴露婴儿的发育，通过多因素统计评价其因果关系。结果发现，即使在这个以往完全被认为是正常的铅暴露范围内，脐血血铅水平与３个月时在Ｂａｙｌｅｙ发育量表上的精神发育指数（ＭＤＩ）和心理运动发育指数（ＰＤＩ）有明确的负相关关系。血铅≥０．４８μｍｏｌ／Ｌ的婴儿在３月龄时的ＭＤＩ和ＰＤＩ明显低于血铅水平＜０．４８μｍｏｌ／Ｌ者，分别相差４．６和８．８分，差异有非常显著意义（Ｐ＜０．０１）。经多元逐步回归分析和多元协方差分析，结果提示这种差异依然存在。提示儿童血铅水平≥０．４８μｍｏｌ／Ｌ时确能对其早期发育产生不利影响。其前瞻性的变化规律正在进一步观察之中     

婴儿腭裂手术对生理发育的影响

我科自１９９５年１１月至１９９９年９月对３６例年龄为５０天至１２个月（平均 ６．５个月）的婴儿进行腭裂手术,分析了婴儿期腭裂手术的优势,腭裂在儿童生长中的生理、心理和对其家长的影响,以及景期手术的必要性,早期手术对发音、颌骨的影响。随访表明,腭裂手术时间选择应越早越好,及早手术对儿童生理和心理的发育有着很重要的意义。因此作者提出了腭裂手术的最佳年龄为１岁以内。     

母乳喂养对婴儿早期骨发育的影响

研究目的探讨母乳喂养对婴儿早期骨发育的影响。研究方法对北京、兰州、重庆的１７２名３月龄婴儿，按母乳喂养和人工喂养分组。采用ＴａｎｎｅｒＷｈｉｔｅｈｏｕｓｅ２法比较两组骨龄发育的状况。结果９１例母乳喂养婴儿中，迟于日历年龄者５０例，正常或超越的为４１例。人工喂养的８１例中，迟于日历年龄者５２例，正常或超越为２９例。ｘ２＝１．５２＜ｘ２０．０５（１），Ｐ＞０．０５。结论母乳喂养与人工喂养婴儿的骨龄比较未出现显著差异。     

Peabody运动发育评估与干预学习班将在京举办

《Peabody运动发育量表》及配套的《运动训练方案》是一套优秀的运动发育监测与干预方案。可用于0～6岁儿童运动发育的评价与早期干预、脑性瘫痪的康复评定与功能训练。该套方案不仅具有较高的专业水准,而且易学易用。     

口腔运动干预改善早产儿脑功能发育的随机对照研究

目的 探讨口腔运动干预(oral motor intervention,OMI)对早产儿脑功能发育的影响.方法 采用分层随机分组方法,将112例早产儿按胎龄分为小胎龄(30～31+6周)及大胎龄(32～33+6周)两层,再随机分为对照组(分别23、22例)和干预组(分别24、23例).对照组予以常规治疗,干预组在此基础...     

补锌对婴幼儿智力及运动发育影响的Meta分析

目的 评价补锌对婴幼儿运动和智力发育改善的作用。目的 评价补锌对婴幼儿运动和智力发育改善的作用。方法 检索 PubMed、EMBASE、Cochrane 图书馆、中国期刊全文数据库、维普中文科技期刊数据库和万方数据库等, 获得补锌对婴幼儿运动和智力发育影响的 RCT文献。 根据随机分配方法,分配隐藏,对研究对象、治疗方案和研究结果测量者采用盲法,结果数据的完整性,选择性报告研究结果,其他偏倚来源进行文献偏倚评估。以生后6~36个月智力发育指数（MDI）、运动发育指数（PDI）和发育商（DQ）为疗效判定指标。采用RevMan 5.0软件进行Meta分析,检验异质性,根据异质性结果进行原因分析,并选择相应的效应模型分析。计量资料以SMD或WMD及其95％CI表示。结果 ①共检索到文献84篇,共10篇RCT满足纳入条件进入Meta分析。7篇文献采用了正确的随机方法,8篇文献采用了分配隐藏,9篇文献对受试者采用了盲法,8篇文献对研究者和结局测量者采用了盲法,9篇文献提及报道数据的完整性,9篇文献未选择性报告研究结果, 仅1篇文献报道了其他偏倚来源。漏斗图检验未见显著发表偏倚。②Meta分析结果显示,补锌组与对照组MDI的差异无统计学意义,WMD=-0.08(95％CI：-1.55～1.40);补锌组与对照组PDI的差异无统计学意义,SMD＝0.15(95％CI：-0.12～0.42)。但研究间均具显著统计学异质性,根据补锌的剂量、是否与其他营养物质合用、纳入对象的营养状况行亚组分析,进一步探讨异质性产生的原因。亚组分析显示不能完全消除文献间的异质性,异质性可能还与其他因素有关。③补锌组与对照组DQ评分的差异无统计学意义,WMD＝-0.72（95％CI：-7.97 ～6.53 ）。补锌组与对照组干预前后Alberta运动指数的差异无统计学意义, WMD＝0.30（ 95％CI：-2.09 ～2.69 ）。结论 早期补锌并未提高MDI、PDI及DQ评分,对婴幼儿运动和智力发育未显示有改善作用。鉴于研究间存在显著的统计学异质性,结论仍需谨慎看待。     

The effect of breastfeeding on child development at 5 years: a cohort study

OBJECTIVE: It is uncertain to what degree the relationship between breastfeeding and later cognitive development is a true biological effect, or is confounded by psychosocial factors. The study aim was to further investigate this relationship and the effect of duration of breast feeding on cognitive development. METHODS: A total of 3880 children were followed from birth. Breastfeeding duration was measured by questionnaire at 6 months of age and a Peabody Picture Vocabulary Test Revised (PPVT-R) was administered at 5 years. PPVT-R scores were adjusted for the effects of a large array of biological and psychosocial confounders. The relationship between breastfeeding and the mean PPVT-R scores were examined using analysis of variance and multiple linear regression. RESULTS: A strong positive relationship was demonstrated between breastfeeding and the PPVT-R scores with increasing scores with increased duration of breastfeeding. After adjusting for a wide range of biological and social factors, the adjusted mean for those breastfed for 6 months or more was 8.2 points higher for females and 5.8 points for males when compared to those never breastfed. CONCLUSION: These findings suggest a significant benefit to child development is conferred by breastfeeding and is related independently to longer periods of breastfeeding.     

Motor Development of Infants with Positional Plagiocephaly

Concurrent with recommendations to place infants to sleep in supine, there has been a dramatic increase in the number of infants with positional plagiocephaly (PP). Recent evidence suggests that infants who have decreased exposure to prone position may have a higher incidence of PP and may be at risk for a delay in the acquisition of certain motor skills. The purpose of this study was to compare motor development between infants with PP and matched peers without PP. We also examined differences in infant positioning practices when asleep and awake between the two groups. Twenty-seven infants with PP, 3 to 8 months of age, were matched by age, gender, and race to infants without PP. Motor performance was evaluated using the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Motor Scales (PDMS). Parents completed a diary that recorded infant positioning over a 3-day period. Mean AIMS percentile score for infants with PP was 31.1 ± 21.6 as compared with 42.7 ± 20.2 in infants without PP (p =. 06). Better performance on the AIMS was positively correlated with the amount of time in prone position when awake, for both groups of children (PP r =. 52, no PP r =. 44, p <. 05). Therapists should be aware of a risk of a motor delay when evaluating infants with PP. It is also important for parents to be informed about the importance of supervised prone playtime to enhance the development of early motor skills.     

Reliability of motor development data in the WHO Multicentre Growth Reference Study

Aim: To describe the methods used to standardize the assessment of motor milestones in the WHO Multicentre Growth Reference Study (MGRS) and to present estimates of the reliability of the assessments.
Methods: As part of the MGRS, longitudinal data were collected on the acquisition of six motor milestones by children aged 4 to 24 mo in Ghana, India, Norway, Oman and the USA. To ensure standardized data collection, the sites conducted regular standardization sessions during which fieldworkers took turns to examine and score about 10 children for the six milestones. Assessments of the children were videotaped, and later the other fieldworkers in the same site watched the videotaped sessions and independently rated performances. The assessments were also viewed and rated by the study coordinator. The coordinator's ratings were considered the reference (true) scores. In addition, one cross-site standardization exercise took place using videotapes of 288 motor assessments. The degree of concordance between fieldworkers and the coordinator was analysed using the Kappa coefficient and the percentage of agreement.
Results: Overall, high percentages of agreement (81–100%) between fieldworkers and the coordinator and "substantial" (0.61–0.80) to "almost perfect" (>0.80) Kappa coefficients were obtained for all fieldworkers, milestones and sites. Homogeneity tests confirm that the Kappas are homogeneous across sites, across milestones, and across fieldworkers. Concordance was slightly higher in the cross-site session than in the site standardization sessions. There were no systematic differences in assessing children by direct examination or through videotapes.
Conclusion: These results show that the criteria used to define performance of the milestones were similar and applied with equally high levels of reliability among fieldworkers within a site, among milestones within a site, and among sites across milestones.     

双胎早产儿神经精神发育水平随访研究

目的 探讨双胎早产儿神经精神发育情况,并分析其危险因素.方法 将2010年6月至2012年6月在昆明医科大学第一附属医院新生儿病房住院的早产几分为2组:双胎早产儿为研究组,单胎早产儿为对照组.对其中88例早产儿在纠正胎龄1岁时行神经精神发育随访,由儿童保健科专人采用贝利婴幼儿发展量表进行测试,其中研究组根据量表正常测试结果分为神经精神发育异常组[智力发展指数(MDI)≤79分]和神经精神发育正常组(MDI ＞79分),并对2组资料进行统计学分析.结果 研究组MDI得分频数分布呈偏态分布,其中59％(27/46例)为神经精神发育异常(MDI≤79分);对照组MDI得分频数分布呈近似正态分布,其中仅12％(5/42例)为神经精神发育异常.1岁时双胎早产儿头围、身长、体质量、MDI、精神运动发展指数(PDI)均低于单胎早产儿,差异均有统计学意义(P均＜0.05).单因素分析中双胎早产儿神经精神发育异常的高危因素有胎龄、出生体质量、母亲育龄、父母亲文化程度、喂养方式、新生儿高胆红素血症、新生儿低血糖症、新生儿脓毒症、感染.多因素Logistic回归分析显示新生儿高胆红素血症是双胎早产儿神经精神发育异常的独立危险因素.结论 同胎龄双胎早产儿的神经精神发育落后于单胎早产儿.新生儿高胆红素血症有可能是导致双胎早产儿神经精神发育异常的高危因素,早期积极处理新生儿高胆红素血症有利于促进双胎早产儿的神经精神发育.     

含二十二碳六烯酸和花生四烯酸的配方奶对婴儿生长发育的研究

目的了解人工喂养的新生儿添加二十二碳六烯酸（ＤＨＡ）和花生四烯酸（ＡＡ）的配方奶喂养后的生长发育情况,以期为人工喂养儿寻求更合理的配方奶。方法３０例人工喂 养的新生儿添加ＤＨＡ和ＡＡ的配方奶喂养,另３０例同性别、胎龄和出生体重拟似,家庭经济状况和父母文化程度相似的新生儿一母乳喂养,观察二组体格和智能发育情况。结果二组婴儿生后２８ｄ、４２ｄ、２个月、４个月时在体重、身高、头围上的差异无显著性意义。Ｐ     

A plea for developmental motor screening in Canadian infants

Motor delays during infancy may be the first observable sign of a specific neurodevelopmental disability or of more global developmental delays. The earlier such disorders are identified, the sooner these infants can be referred for early intervention services. Although developmental motor screening is strongly recommended in other Western countries, Canada has yet to provide a developmental surveillance and screening program. Ideally, screening for motor disabilities should occur as part of the 12-month well-baby visit. In advance of that visit, parents can be provided with a parent-screening questionnaire that they can complete and bring with them to their 12-month office visit. Interpretation of the parent-completed questionnaire takes only 2 min to 3 min of the health care professional’s time and, based on the results, can either reassure parents that their infant is developing typically, or lead to a referral for standardized motor screening or assessment by a paediatric physical or occupational therapist.