The predictive value of writhing stage general movement assessment for motor development outcomes in infants with severe neonatal jaundice
10.3760/cma.j.issn.2096-2932.2019.03.006
- VernacularTitle:全身运动扭动阶段评估对重度黄疸患儿运动发育结局的预测价值
- Author:
Zhouli WU
1
;
Ning TAN
;
Yuee XIE
;
Tingjiao SHI
;
Aiping CAO
;
Ruokun TAN
;
Shulan FEI
Author Information
1. 湖南省郴州市第一人民医院新生儿科 423000
- Keywords:
Hyperbilirubinemia,neonatal;
Kernicterus;
General movements assessment;
Motor development
- From:Chinese Journal of Neonatology
2019;34(3):187-191
- CountryChina
- Language:Chinese
-
Abstract:
Objective To study the predictive values of the general movements (GMs) assessment in writhing stage for motor development outcomes in infants with severe neonatal jaundice.Method From December of 2012 to December of 2017,infants with severe neonatal jaundice (serum bilirubin reaching the corresponding level of exchange transfusion according to the reference nomogram) in our hospital were enrolled in the study.Inclusion criteria included corrected gestational age of 37 to 48 weeks,serum bilirubin level below phototherapy intervention value after treatment and general and detailed assessment were carried out in writhing stage when the infant was stable.The patients were regularly followed-up until one-year-old to evaluate the predictive values.Result A total of 241 patients with severe neonatal jaundice were enrolled in the study,including 153 males (63.5％) and 88 females (36.5％),with gestational age between 35 and 42 weeks.The mean gestational age was (37.9± 1.8) weeks,the average birth weight was (3 057±480) g,and the mean serum bilirubin value was (458.9± 119.1) μmol/L.The general evaluation of the GMs was normal in 15 cases (6.2％),and abnormal in 226 cases (93.8％) with 217 cases (90.0％) were poor repertoire (PR) and 9 cases (3.7％) were cramped-synchronized (CS).The predictive values of abnormal GMs for abnormal motor development outcomes were as following:sensitivity 100％,specificity 7.6％,negative predictive value(NPV) 100％.The predictive values of CS for cerebral palsy were as following:sensitivity 22.2％,specificity 97.8％,NPV 94.0％.Detailed evaluation of 241 subjects showed that 13 items had statistically significant differences in the prediction of cerebral palsy (P＜0.05),and 18 items in the prediction of abnormal motor development (P＜0.05).Conclusion The CS pattern and detailed assessment of GMs in the writhing stage may be correlated with the outcomes of motor development in infants with severe neonatal jaundice until one-year-old.
