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低出生体重児における脳性麻痺児のブラゼルトン新生児行動評価の分析


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Title: 低出生体重児における脳性麻痺児のブラゼルトン新生児行動評価の分析
Other Titles: The Neonatal Behavioral Assessment Scale (NBAS) as a Predictor of Cerebral Palsy among Low Birthweight Infants
Authors: 穐山, 富太郎 / 大城, 昌平 / 高橋, 達也 / 福田, 雅文
Issue Date: 18-Mar-2001
Publisher: 社団法人日本リハビリテーション医学会
Citation: リハビリテーション医学. 2001, 38(3), p.211-218
Abstract: 低出生体重児を対象として, NBASによる脳性麻痺児の診断活用の有用性を検討した. 修正胎齢36?44週の期間に施行した3回のNBASの評価結果を正常発達児と比較した結果, 脳性麻痺児群は, すべての行動クラスターで有意に低値, 誘発反応クラスターで有意に高値であった. 逐次変数増減変数選択法によるロジスティック回帰分析の結果, 脳性麻痺児の特徴は, 満期前には運動系と自律神経系, 満期時以降は運動系と誘発反応の異常が顕著であった. ロジスティックモデルによる判別の結果, 感度は85?93%, 特異度は97%であった. NBASは脳性麻痺児の診断としても有用な評価法であると思われた. (リハ医学2001 ; 38 : 211-218) / The purpose of this study was to investigate relationship between newborn's behavior patterns as measured by the Neonatal Behavioral Assessment Scale (NBAS) and long-term cerebral palsy (CP) as a neurological outcome among low birthweight infants. The subjects of this case-control study were low birthweight infants admitted to the NICU at the Nagasaki University Hospital between 1988 and 1994. The study subject consisted of 292 infants, with mean gestational age of 32.6 weeks and mean birth weight of 1648.6 grams. These infants were examined using NBAS at 36 weeks, at 40 weeks and at 44 weeks post-conceptional age (PCA). Each of infants was examined at five years of age again to measure its development status on standardized assessments. Logistic regression analysis was performed to examine the relationship between newborn's behavioral patterns in NBAS cluster scores and developmental status at five years, At five years of age, 148 infants were categorized within the normal range, 46 were categorized borderline and mental retardation, 14 died and 15 were diagnosed as having CP. The remaining 69 could not be contacted. The NBAS cluster scores of the 15 infants who were diagnosed CP were compared with the NBAS scores of the normal infants. NBAS cluster scores in the 15 newborn infants diagnosed as having CP five years later were significantly lower than in normal on Mann-Whitney U Tests. In the logistic regressions analysis, Motor (p<0.01) and Autonomic (P<0.04) clusters at 36?38 weeks PCA, Motor (P<0.00) and Reflexes (P<0.02) clusters at 40?42 weeks and Reflex cluster (p<0.01) at 44 weeks, was significantly related to indicated characteristics of CP. Sensitivity and specificity at the NBAS examinations were very high (85.6?93.3% and 96.6?96.9%, respectively) in discriminate analysis. The results of the study would confirm the usefulness of the NBAS as a predictor of CP and the validity of prediction using NBAS as a diagnostic tool for identifying the early indicators of CP. The results may suggest that the NBAS, when used serially in the postnatal period, not only can help identify neonares who are at risk for CP but it can help clinicians develop anagement protocol for infants with cerebral palsy. (Jpn J Rehabil Med 2001 ; 38 : 211-218)
Keywords: ブラゼルトン新生児行動評価 / 低出生体重児 / 脳性麻痺児 / 早期診断
URI: http://hdl.handle.net/10069/21765
ISSN: 0034351X
Relational Links: http://ci.nii.ac.jp/naid/110001847455/
Rights: 社団法人日本リハビリテーション医学会 / 本文データは学協会の許諾に基づきCiNiiから複製したものである
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/21765

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