General Movements in Very Preterm Children and Neurodevelopment at 2 and 4 Years
General Movements in Very Preterm Children and Neurodevelopment at 2 and 4 Years
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DOI：
10.1542/peds.2013-0177
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发表时间：
2013-08-01
期刊：
影响因子：
8
通讯作者：
Doyle, Lex W.
中科院分区：
文献类型：
--
作者：
Spittle, Alicia J.;Spencer-Smith, Megan M.;Doyle, Lex W.
目的：尽管近50%的极早产（VP）儿童存在神经发育障碍，但早期预测婴儿在以后的生活中会遇到问题仍然是一个挑战。本研究评估了1个月和3个月矫正年龄时的一般运动（GM；自发运动和内源性运动）对VP儿童2岁和4岁时神经发育的预测价值。方法：在矫正月龄1个月和3个月时，对妊娠30周出生的婴儿进行GM评估为正常或异常。使用Bayley婴幼儿发展量表（第三版）评估2岁时的运动、认知和语言发展。4岁时，使用差异能力量表（第二版）评估认知和语言结果，使用儿童运动评估量表（第二版）评估运动结果；诊断为脑瘫。结果：招募了99名VP婴儿，分别在2岁和4岁时随访了97%和88%的幸存者。1个月时异常的GM与2年和4年时较差的运动结果相关，但与语言或认知结果无关。3个月时异常的GM与2年和4年时较差的运动、认知和语言预后相关。总的来说，1个月的GM对2岁和4岁的损伤表现出更好的敏感性，而3个月的GM在区分有和没有损伤的儿童方面具有更好的特异性和更准确的总体。结论：VP婴儿的异常GM，特别是在产后3个月，预示着2岁和4岁时神经发育恶化。
OBJECTIVE: Although similar to 50% of very preterm (VP) children have neurodevelopmental impairments, early prediction of infants who will experience problems later in life remains a challenge. This study evaluated the predictive value of general movements (GM; spontaneous and endogenous movements) at 1 and 3 months' corrected age for neurodevelopment at 2 and 4 years of age in VP children.METHODS: At 1 and 3 months' corrected age, infants born,30 weeks' gestation had GM assessed as normal or abnormal. Motor, cognitive, and language development at 2 years was assessed by using the Bayley Scales of Infant and Toddler Development, Third Edition. At 4 years, cognitive and language outcomes were assessed by using the Differential Ability Scale-Second Edition and motor outcomes with the Movement Assessment Battery for Children-Second Edition; a diagnosis of cerebral palsy was documented.RESULTS: Ninety-nine VP infants were recruited, with 97% and 88% of survivors followed up at age 2 and 4 years, respectively. Abnormal GM at 1 month were associated with worse motor outcomes at 2 and 4 years but not language or cognitive outcomes. Abnormal GM at 3 months were associated with worse motor, cognitive, and language outcomes at both 2 and 4 years. Overall, GM at 1 month demonstrated better sensitivity to impairments at 2 and 4 years, whereas GM at 3 months had better specificity and were more accurate overall at distinguishing between children with and without impairment.CONCLUSIONS: Abnormal GM in VP infants, particularly at 3 months postterm, are predictive of worse neurodevelopment at ages 2 and 4 years.