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早产与脑瘫、发育性运动协调障碍文献学习

37周前出生的小儿为早产儿。由于各种生物和环境的高危因素,早产儿不同程度地运动障碍的发生率显著增加,胎龄越小运动障碍的发病风险越大;其中,最严重的运动障碍是脑性瘫痪(简称脑瘫)。全球的研究表明,脑瘫占每年出生小儿的0.1%-0.2%。而2008年一项文献系统回顾表明,22-27周早产儿脑瘫发病率可达14.6% (95%可信区间为:12.5%-17%)28-31周早产儿脑瘫发病率为6.2% (95%可信区间为:4.9%-7.8%)32-36周早产儿脑瘫发病率为0.7% (95%可信区间为:0.6%-0.9%)Himpens E, et al.Prevalence, type, distribution, and severity of cerebral palsy in relation to gestationalage: a meta-analytic review. Dev Med Child Neurol 2008;50:334-40.

轻、中度的运动障碍可能不至于严重影响最终的运动发育结局,可表现为手的灵活性欠佳、身体平衡性差以及球类运动中的协调能力欠佳。但是,这种运动能力的不足可导致日常生活和学习能力受到影响,这组神经发育障碍性疾病目前已经得到全球的重视,并称之为发育性运动协调障碍developmental coordination disorderDCD)。研究表明,50%的早产儿有发育性运动协调障碍。

不同程度的运动障碍将明显影响早产儿成年后的生活质量、学习成绩以及参加课外活动表现。

因而,需要重视早产儿的医学随访。早产儿的医学随访除了常规医学检查项目外,还需要在发育儿科定期行高危儿神经运动发育检查。婴儿期的神经运动学检查、全身运动质量评估等可早期识别运动障碍,如有异常,需要尽快早期干预。

需要强调的是,早产儿神经运动发育随访至少应到学龄前期。

编译内容来自:

Cerebral palsy and developmentalcoordination disorder in children born preterm.Spittle AJ, Orton J. SeminFetal Neonatal Med. 2014 Apr;19(2):84-9.

Abstract

Children born early (<37 weeks of gestation) are at high risk of arange of motor impairments due to a variety of biological and environmentalrisk factors. Cerebral palsy occurs more frequently in those children bornpreterm, with the risk increasing with decreasing gestational age. Mild andmoderate motor impairments, consistent with developmental coordinationdisorder, occur in almost half of those children born preterm and includedifficulties with balance, manual dexterity and ball skills. All forms of motorimpairment are associated with comorbidities, which may have a greater effecton quality of life, academic achievement and participation in extracurricularactivities than the motor impairment itself. Infants at risk of motorimpairment can be identified in early infancy with a combination of clinicalassessment tools and perinatal risk factors. However, the reliable diagnosis ofmotor impairment requires follow-up into early childhood and it is important toensure that the appropriate intervention is implemented.

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