QUALITATIVE CHANGES OF GENERAL MOVEMENTS IN PRETERM INFANTS WITH BRAIN-LESIONS
QUALITATIVE CHANGES OF GENERAL MOVEMENTS IN PRETERM INFANTS WITH BRAIN-LESIONS
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DOI：
10.1016/0378-3782(90)90013-9
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发表时间：
1990-09-01
影响因子：
2.5
通讯作者：
PRECHTL, HFR
中科院分区：
文献类型：
--
作者：
FERRARI, F;CIONI, G;PRECHTL, HFR
本研究的目的是：(1)重复之前对低风险和高风险早产儿运动活动的定量研究，(2)应用一种新的方法系统分析这两组婴儿一般运动的定性特征。对未受刺激的婴儿在保温箱中连续一小时的录像在早产期间进行，并在产后期间继续进行，直到大约20周。高危组仅包括在反复的脑部超声检查中有出血和/或白质软化征象的婴儿。神经学随访持续到矫正年龄至少1年，最多3年。对12对低危和高危早产儿的各种运动模式进行量化分析，发现低危早产儿在活动阶段有轻微但显著（P = 0.05）的单独手臂运动过量。其他运动模式无显著差异。产前一般运动的定性评估结果显示，14例低风险病例中，除1例外，其余患者的一般运动质量正常。病变组（N = 29）患儿在早产期间均出现异常。8例后来神经功能恢复正常，但其中1例有斜视。此外，一名婴儿失明（ROP）和智力低下，另一名患有智力低下。19名婴儿后来发展为脑瘫（2名单侧瘫痪，3名偏瘫，5名双侧瘫痪，9名四肢瘫痪）。29例患者中有48.3%存在斜视。对异常一般运动的各个方面的半定量估计使异常模式的类型学成为可能。个别病例发展轨迹的图形显示，沿着时间轴描绘异常方面的过程，有助于记录异常迹象的演变。与成像技术检测到的病变的性质和部位相比，它们的病程更能预测神经系统的预后。从录像中对一般动作进行定性评估是一种可靠、快速、廉价且完全非侵入性的方法，可用于新生儿神经系统功能损伤的早期检测。
The aims of the study were (1) to replicate previous quantitative studies of motor activity in low-risk and high-risk preterm infants and (2) to apply a new method of systematic analysis of the qualitative characteristics of general movements in these two groups of infants. Sequential one-hour videorecordings of the unstimulated infants in the incubator were made during the preterm period and the continued during the postterm period until about 20 weeks. The high-risk group consisted only of infants with signs of haemorrhage and/or leucomalacia in the repeated ultrasonograms of the brain. The neurological follow-up continued up to a minimum of one and a maximum of three years of corrected age. The quantification of the various motor patterns in 12 hatched pairs of low-risk and high-risk preterm infants revealed a slight but significant (P = 0.05) excess of isolated arm movements in the low-risk cases during the activity phase. No other movement pattern differed significantly. The qualitative assessment of general movements during the preterm period resulted in all but one of the 14 low-risk cases having a normal quality of general movements. In the lesion-group (N = 29) all the infants had an abnormal quality during the preterm period. Eight cases later became neurologically normal although 1 of them had strabism. In addition, one infant was blind (ROP) and retarded and one other had mental retardation. Nineteen infants later developed cerebral palsy (two monoplegia of a leg, three hemiplegia, 5 diplegia and 9 quadriplegia). Strabism was present in 48.3% of the whole group of 29 cases. A semi-quantitative estimation of various aspects of the abnormal general movements made a typology of abnormal patterns possible. A graphic display of developmental trajectories of individual cases, depicting the course of abnormal aspects along the time axis, helps document the evolution of abnormal signs. Their course is a better predictor of the neurological outcome than the nature and localization of the lesion, detected by imaging techniques. The qualitative assessment of general movements from videorecordings is a reliable, quick, cheap and totally non-intrusive method in neonatology for the early detection of functional impairment of the nervous system.