Correlation between General Movements and Risk Factors in Infants with High Risk for Developmental Delay

• Main Authors: Ya-ChingKo, 柯雅菁
• Other Authors: Bih-Jen Hsue
• Format: Others
• Language: en_US
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/3eway2

碩士 === 國立成功大學 === 物理治療學系 === 104 === Background and Purpose: Small for gestational age (SGA), abnormal brain ultrasound (AbUS), very low birth weight (VLBW), or chronic lung disease (CLD) are considered as high risk factors of developmental delay. General movements (GMs) are claimed to be endogenous and the qualities of GMs may reflect the maturation and status of an infant’s nervous system. The purpose of this study was to examine the relationships between GMs and above four high risk factors. Methods: Twenty-one term infants (control group), 25 preterm infants without other high risk factors (premature group), and 46 infants with at least one of following conditions, High risk group (HRG) had four subgroups including SGA, AbUS, VLBW or CLD. Forty-six, 81 and 60 recordings were collected and rated in preterm, writhing and fidgety periods, respectively. GMs were categorized as normal or abnormal. AbUS were divided into two subdivisions, minor AbUS including mild AbUS or initially AbUS but followed normal ultrasound findings and severe AbUS including moderate or severe AbUS. The relationships between SGA, AbUS, VLBW, CLD or multiple risk factors and GMs were determined by Fisher’s exact test; Cramer’s V test was used to examine the relationships between GMs and non-, minor and severe AbUS. Binary logistic regression was applied to determine the contribution of each risk factor to probability of abnormal GMs. Results and Discussion: SGA was not related to abnormal GMs, but SGA had high percentage of abnormal GMs in the preterm period. “Brain sparing” which may prevent severe brain injury in uterus, and restored supplies of nutrition after birth may be another possible reason that contribute to high incident of early abnormal GMs in SGA. AbUS was related to abnormal GMs in each period. In further examinations, minor AbUS was related to abnormal GMs in the preterm and writhing periods, while severe AbSU was related to abnormal GMs in the fidgety period. The increased severity of AbUS was correlated to abnormal GMs in each period. The possible reasons may be that early abnormal GMs and minor AbUS were attribute to transient brain dysfunction while severe AbUS and abnormal fidgety GMs may attribute to permanent brain dysfunction; however, further study is needed to confirm this speculation. VLBW was related to abnormal GMs in the preterm and writhing periods. Ten participants with VLBW all had AbUS. CLD was not related to abnormal GMs, but incidents of abnormal GMs were high in the preterm and writhing periods. Only 6 participants with CLD and they all had AbUS and VLBW. Logistic regression indicated that among these risk factors, only AbUS had significantly effect on GMs in each period. Minor AbUS was at higher risk for abnormal GMs in the preterm period, while severe AbUS had 20 times of risk for abnormal GMs in the fidgety period in comparison with non-AbUS. When examining the correlation between multiple risk factors (including two or three risk factors) and GMs, multiple risk factors including SGA were related to abnormal GMs in the preterm and writhing periods, while multiple risk factors including risk factors other than SGA were related to abnormal GMs in each period. Conclusions: This study revealed that AbUS were consistently related to abnormal GMs, while VLBW were related to abnormal GMs in the preterm or writhing periods. SGA and CLD did not related to abnormal GMs. Increased severity of AbSU was related to GMs in each period. Although HRG including 46 participants, the GMs recordings of every participant was not available for examination in the three periods. Particularly, few participants had CLD, and all of them had VLBW and AbUS. Further study is needed to examine the long-term effect of each high risk factor on neurodevelopment by enlarging the sample size in each risk factor and following up the participants.