Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Study on the neurodevelopmental predictors for the results of the Bayley Scales of Infant Development II in high-risk neonates

고위험 신생아에서 Bayley 발달 검사 결과에 영향을 미치는 신경발달 예후인자에 대한 연구

  • Woo, Mi Kyeong (Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Kim, Dong Wook (Department of Pediatrics, Andong Hospital) ;
  • Huh, Kyoung (Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Shim, Gyu Hong (Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine) ;
  • Chey, Myoung Jae (Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine)
  • 우미경 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 김동욱 (안동병원 소아청소년과) ;
  • 허경 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 심규홍 (인제대학교 의과대학 상계백병원 소아청소년과) ;
  • 최명재 (인제대학교 의과대학 상계백병원 소아청소년과)
  • Received : 2009.06.15
  • Accepted : 2009.10.19
  • Published : 2009.11.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose:To identify the risk factors for poor neurodevelopmental outcomes in high-risk neonates. Methods:We studied 94 infants admitted to the neonatal intensive care unit at the Sanggye Paik Hospital between January 2002 and November 2005 and evaluated the follow-up data. The following events were considered as risk factors: ${\leq}32$ weeks of gestation, very low birth weight, Apgar scores of less than 5, neonatal resuscitation, neonatal seizure, congenital infection, and abnormalities in cranial ultrasound or magnetic resonance imaging (MRI). The infants who had any one of these risk factors were included. They were evaluated at their mean corrected age of 13.84${\pm}$8.03 months. Mental and Psychomotor Developmental Indices (MDI, PDI) were determined by a clinical psychologist using the Bayley Scales of Infant Development II. Results:The mean MDI and PDI of all the patients were 96.28${\pm}$26.70 and 94.00${\pm}$22.80, respectively. Abnormalities on cranial ultrasound or MRI were significant predictors of both low MDI (P<0.05) and low PDI (P<0.001). These abnormalities showed a stronger association with low PDI than with low MDI. The infants with periventricular leukomalacia had the lowest MDI and PDI ($70.10{\pm}28.68$ and $69.70{\pm}24.91$, respectively). Apgar score at 1 minute and very low birth weight were also significant predictors for low PDI (P<0.05, P<0.05, respectively). Conclusion:Image findings with cranial ultrasound or MRI were the strongest predictors of neurodevelopmental outcome. Periventricular leukomalacia was the best predictive factor for mental and psychomotor development.

목 적:신생아 집중치료술이 발달함에 따라 미숙아 및 극소 저체중 출생아 등의 고위험 신생아의 생존율이 크게 향상되었다. 따라서 이러한 고위험 신생아의 생존율 향상과 더불어 생존 환아에서 발육 지연, 뇌성마비, 청력 저하 등 신경학적 발달 이상을 보이는 환아의 수도 증가하여 이들 환아들의 이상을 보다 조기에 발견하기 위해 추적 관찰의 필요성이 증대되고 있다. 저자들은 신생아 집중 치료실에서 치료 후 퇴원한 환아 중 위험한 주산기 인자들로 인하여 발달 이상의 위험도가 상대적으로 높아 고위험 신생아로 추적 관리를 받고 있는 환아에서 Bayley 발달 검사를 이용하여 발달 이상의 위험 인자를 확인하기 위하여 연구를 시행하였다. 방 법:2002년 1월부터 2005년 11월까지 인제대학교 의과대학 상계백병원 신생아 집중 치료실에 입원하였던 신생아 중에서 퇴원 후 외래에서 추적 관리하였던 환아 중 Bayley 발달 검사를 시행한 94례를 대상으로 하였다. 연구 대상은 32주 미만의 재태 연령, 극소 저체중 출생아, 5점 이하의 Apgar 점수, 뇌 초음파 및 자기 공명 검사상 뇌실 내 출혈 혹은 뇌실주위 백색질 연화증 등의 이상, 신생아 소생술을 시행한 경우, 신생아 경련 또는 선천성 감염 중 한 가지 이상의 요인이 있었던 환아이다. 대상 환아들의 발달 검사로 Bayley 발달 검사(Bayley Scales of Infant Development II)를 임상심리치료사가 시행하였고, MDI와 PDI를 분석에 이용하였다. 결 과:뇌 초음파 및 자기 공명 검사는 MDI, PDI와 각각 통계적인 연관성을 보였으며(P<0.05, P<0.001), 뇌실주위 백색질 연화증의 경우 MDI는 $70.10{\pm}28.68$, PDI는 $69.70{\pm}24.91$로 의미 있게 낮은 점수를 보였다. MDI보다 PDI가 뇌의 영상학적 검사 소견과 상관관계가 더 큰 것으로 나타났다. PDI는 1분 Apgar 점수 및 극소 저체중 출생아와도 유의한 상관관계가 있었다(P<0.05, P<0.05). Bayley 발달 검사 결과는 성별, 재태 연령, 신생아 소생술 여부, 신생아 경련과 유의한 연관성이 없었다. 결 론:신생아 집중 치료실에서 치료받은 고위험 신생아를 추적 관찰하며 Bayley 발달 검사를 시행하였을 때, 검사 결과에 독립적으로 영향을 미치는 위험 인자는 뇌의 영상학적 검사 소견, 1분 Apgar 점수 및 극소 저체중 출생아였다. 그 중 뇌의 영상학적 검사 소견상 이상이 있는 경우 발달 장애의 가능성이 가장 높고, 그 외의 위험 요인에 대해서도 주기적인 추적 관찰이 중요할 것으로 생각된다.

Keywords

Acknowledgement

Supported by : Inje University

References

  1. Lee SK, Lee JH, Lee SG. Changes of neurodevelopmental outcomes and risk factors of very low birth weight infants below 1,500 g, in the last 10 years. Korean J Pediatr 2006; 49:1050-5 https://doi.org/10.3345/kjp.2006.49.10.1050
  2. Jeon GW, Kim MJ, Kim SS, Shim JW, Chang YS, Park WS, et al. Improved survival rate with decreased neurodevelopmental disability in extreme immaturity. Korean J Pediatr 2007;50:1067-71 https://doi.org/10.3345/kjp.2007.50.11.1067
  3. Stoelhorst GM, Rijken M, Martens SE, van Zwieten PH, Feenstra J, Zwinderman AH, et al. Developmental outcome at 18 and 24 months of age in very preterm children: a cohort study from 1996 to 1997. Early Hum Dev 2003;72:83-95 https://doi.org/10.1016/S0378-3782(03)00011-2
  4. Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993-1994. Pediatrics 2000;105:1216-26 https://doi.org/10.1542/peds.105.6.1216
  5. Bayley N. Bayley scales of infant development. 2nd ed. San Antonio: TX Psychologicol Co, 1993
  6. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978;92:529-34 https://doi.org/10.1016/S0022-3476(78)80282-0
  7. Shin SM, Chang YP, Lee ES, Lee YA, Son DW, Kim MH, et al. Low Birth Weight, Very Low Birth Weight Rates of Newborn Infants in Korea. J Korean Soc Neonatol 2005; 12:233-7
  8. Ma TH, Lee YK, Kim KA, Ko SY, Kim MJ, Shin SM. Outcome of very low birth weight infants in past 2 years at Samsung Cheil Hospital. J Korean Soc Neonatol 2003;10: 7-13
  9. Washburn LK, Dillard RG, Goldstein DJ, Klinepeter KL, deRegnier RA, O'Shea TM. Survival and major neurodevelopmental impairment in extremely low gestational age newborns born 1990-2000: a retrospective cohort study. BMC Pediatr 2007;7:20 https://doi.org/10.1186/1471-2431-7-20
  10. D'Angio CT, Sinkin RA, Stevens TP, Landfish NK, Merzbach JL, Ryan RM, et al. Longitudinal, 15-year follow-up of children born at less than 29 weeks' gestation after introduction of surfactant therapy into a region: neurologic, cognitive, and educational outcomes. Pediatrics 2002;110: 1094-102 https://doi.org/10.1542/peds.110.6.1094
  11. Fily A, Pierrat V, Delporte V, Breart G, Truffert P. Factors associated with neurodevelopmental outcome at 2 years after very preterm birth: the population-based Nord-Pas-de- Calais EPIPAGE cohort. Pediatrics 2006;117:357-66 https://doi.org/10.1542/peds.2005-0236
  12. Delobel-Ayoub M, Kaminski M, Marret S, Burguet A, Marchand L, N'Guyen S, et al. Behavioral outcome at 3 years of age in very preterm infants: the EPIPAGE study. Pediatrics 2006;117:1996-2005 https://doi.org/10.1542/peds.2005-2310
  13. Als H, Gilkerson L, Duffy FH, McAnulty GB, Buehler DM, Vandenberg K, et al. A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects. J Dev Behav Pediatr 2003;24: 399-408 https://doi.org/10.1097/00004703-200312000-00001
  14. Farooqi A, Hagglof B, Sedin G, Gothefors L, Serenius F. Mental health and social competencies of 10- to 12-year- old children born at 23 to 25 weeks of gestation in the 1990s: a Swedish national prospective follow-up study. Pediatrics 2007;120:118-33 https://doi.org/10.1542/peds.2006-2988
  15. Hack M, Wilson-Costello D, Friedman H, Taylor GH, Schluchter M, Fanaroff AA. Neurodevelopment and predictors of outcomes of children with birth weights of less than 1000 g: 1992-1995. Arch Pediatr Adolesc Med 2000;154: 725-31 https://doi.org/10.1001/archpedi.154.7.725
  16. Whitaker AH, Feldman JF, Lorenz JM, Shen S, McNicholas F, Nieto M, et al. Motor and cognitive outcomes in nondisabled low-birth-weight adolescents: early determinants. Arch Pediatr Adolesc Med 2006;160:1040-6 https://doi.org/10.1001/archpedi.160.10.1040
  17. Marlow N, Wolke D, Bracewell MA, Samara M. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005;352:9-19 https://doi.org/10.1056/NEJMoa041367
  18. Kang JW, Lee KS. Prognostic factors of developmental delay in premature infants. J Korean Child Neurol Soc 2007;15: 67-74
  19. Iype M, Prasad M, Nair PM, Geetha S, Kailas L. The newborn with seizures -- a follow-up study. Indian Pediatr 2008;45:749-52
  20. Lee JU, Choi WJ, Kim CS, Lee SL, Kim JS. The significance of the early electroencephalographic findings in severely asphyxiated newborn infants. J Korean Pediatr Soc 2003;46: 784-8
  21. van de Bor M, den Ouden L, Guit GL. Value of cranial ultrasound and magnetic resonance imaging in predicting neurodevelopmental outcome in preterm infants. Pediatrics 1992;90:196-9
  22. Vohr BR, Wright LL, Poole WK, McDonald SA. Neurodevelopmental outcomes of extremely low birth weight infants <32 weeks' gestation between 1993 and 1998. Pediatrics 2005;116:635-43 https://doi.org/10.1542/peds.2004-2247
  23. Lee HJ, Park SH, Na KH, Park SY, Kim EY, Kim KS, et al. Developmental assessment of preterm infants at two years of age with periventricular leukomalacia. J Korean Soc Neonatol 2002;9:167-75
  24. Patra K, Wilson-Costello D, Taylor HG, Mercuri-Minich N, Hack M. Grades I-II intraventricular hemorrhage in extremely low birth weight infants: effects on neurodevelopment. J Pediatr 2006;149:169-73 https://doi.org/10.1016/j.jpeds.2006.04.002
  25. De Vries LS, Van Haastert IL, Rademaker KJ, Koopman C, Groenendaal F. Ultrasound abnormalities preceding cerebral palsy in high-risk preterm infants. J Pediatr 2004;144:815- 20 https://doi.org/10.1016/j.jpeds.2004.03.034
  26. Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006;355:685-94 https://doi.org/10.1056/NEJMoa053792
  27. O'Shea TM, Kuban KC, Allred EN, Paneth N, Pagano M, Dammann O, et al. Neonatal cranial ultrasound lesions and developmental delays at 2 years of age among extremely low gestational age children. Pediatrics 2008;122:e662-9 https://doi.org/10.1542/peds.2008-0594
  28. Kinney HC. The near-term (late preterm) human brain and risk for periventricular leukomalacia: a review. Semin Perinatol 2006;30:81-8 https://doi.org/10.1053/j.semperi.2006.02.006
  29. O'Rourke D, Bradley L, King MD, Ryan S. Leukoencephalopathy with anterior temporal cysts due to congenital CMV infection diagnosed retrospectively. J Neuroimaging. 2008, Sep 22. [Epub ahead of print]
  30. Adams-Chapman I, Stoll BJ. Neonatal infection and long- term neurodevelopmental outcome in the preterm infant. Curr Opin Infect Dis 2006;19:290-7 https://doi.org/10.1097/01.qco.0000224825.57976.87
  31. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292:2357-65 https://doi.org/10.1001/jama.292.19.2357
  32. Wood NS, Costeloe K, Gibson AT, Hennessy EM, Marlow N, Wilkinson AR. The EPICure study: associations and antecedents of neurological and developmental disability at 30 months of age following extremely preterm birth. Arch Dis Child Fetal Neonatal Ed 2005;90:F134-40 https://doi.org/10.1136/adc.2004.052407
  33. Whitaker AH, Feldman JF, Van Rossem R, Schonfeld IS, Pinto-Martin JA, Torre C, et al. Neonatal cranial ultrasound abnormalities in low birth weight infants: relation to cognitive outcomes at six years of age. Pediatrics 1996;98:719-29

Cited by

  1. Study on the Effects of the Family Support in the Very Low Birth Weight Infants Follow-Up: Focus on Dodam Dodam Bring-Up Center vol.25, pp.2, 2014, https://doi.org/10.14734/kjp.2014.25.2.75