Predictive Ability of Early Neuromotor Examinations on Walking Attainment in Very-Low-Birth-Weight infants at 18 Months Corrected Age

早期神經動作評估對于極低出生體重早產兒在矯正年齡十八個月時行走達成的預測力

鄭素芳(Suh-Fang Jeng) ； 謝武勳(Wu-Shiun Hsieh)

《物理治療》 29卷1期 (2004/02) Pp. 9-20

摘要

研究目的：中文版新生兒神經行為量表與阿爾伯塔嬰兒動作評估用以評估早產兒早期的神經動作發展具臨床方便性、可信度、與反應性，然而對於神經發展預後的預測性資料則相當有限。因此本研究的目的為探討以上神經動作評估對於極低出生體重兒在矯正年齡18個月時之行走達成的預測性，以及增加週產期與社會人口統計的訊息是否能提高其預測性。方法：本研究包括130名極低出生體重兒與60名足月兒，於足月時以及矯正年齡4、6、9、和12個月時分別接受中文版新生兒神經行為量表與阿爾伯塔嬰兒動作評估的測試，並追蹤其行走達成之年齡直到矯正年齡36個月為止，週產期與社會人口統計的資料則是經由回顧病歷記錄而得。結果：所有的足月兒皆於矯正年齡18個月之前達成行走；而極低出生體重兒中則有17人(13.1%)未能達成。神經動作評估對於極低體重兒矯正年齡18個月時之行走達成的預測，於足月、4、6、9、以及12個月之預測準確度分別為77.7%、81.2%、84.8%、96.4%、和97.5%。增加週產期的資料對早期年齡的神經動作分數能夠顯著地提高其預測準確度至83.4%-95.1%，至於能夠顯著提高預測力之週產期因素包括：妊娠週數、腦室内出血、慢性肺疾病、以及視網膜病變。結論：神經動作評估對於早產兒矯正年齡18個月時行走達成之預測，若在9個月之後使用具極高準確性。若是增加考慮週產期的因素則可以改善其在早期的預測能力。

關鍵字

週產期因子 ； 神經動作評估 ； 預測效度 ； 早產 ； 行走發展

並列摘要

Background and Purposes: The Neonatal Neurobehavioral Examination-Chinese version(NNE-C)and the Alberta Infant Motor Scale(AIMS)have been found clinically feasible, reliable, and responsive when used to examine the early neuromotor development of preterm infants. However, the data concerning their predictive ability on neurodevelopmental outcome were limited. The purpose of this study was therefore to examine the predictability of these neuromotor examinations on walking attainment in very-low-birth-weight (VLBW) infants at 18 months corrected age, and to determine if adding perinatal and socio-demographic information enhances the predictability. Methods: One hundred and thirty VLBW infants and 60 full-term infants were administered the NNE-C at term age and the AIMS at 4,6,9,and 12 months corrected age, and were followed for age of walking attainment until 36 months corrected age. Perinatal and socio-demographic data were collected through review of medical records. Results: All full-term infants attained walking ability by 18 months corrected age; while 17(13.1%)VLBW infants failed to do so. The predictive accuracy of the neuromotor examinations at term, 4, 6, 9,and 12 months on walking attainment at 18 months corrected age in the VLBW infants was 77.7%, 81.2%, 84.8%, 96.4%, and 97.5% respectively. Adding perinatal data (i.e.gestational age, intra-ventricular hemorrhage, chronic lung disease, and retinopathy of prematurity) to the neuromotor scores at earlier ages in the model significantly increased the predictive accuracy to 83.4%-95.1%.Conclusions: Neuromotor examination can reasonably predict the walking attainment at 18 months corrected age in preterm infants after 9 months. Addition of perinatal information in the model improves its predictive ability in the earlier months of life.

並列關鍵字

Perinatal factors ； Neuromotor test ； Predictive validity ； Prematurity ； Walking