| Objective:Based on the study of general movements speciality of high-risk infants,the early warning score of cerebral palsy in 2-month-old infants was established to provide early assessment and early intervention for high-risk infants with different risk levels of neurological development.It also provides effective clinical data for the rehabilitation of high-risk infants.Method:1.After the review by the ethics Committee of our hospital,we extracted the high-risk children from January 2015 to January 2016 for the establishment of follow-up files in the department of rehabilitation according to the principle of informed consent and voluntary participation.The general movements feature evaluation and refinement score were done at 2-month-old(correcting age 4-8 weeks).Meanwhile,52 neurological exercises(including passive muscular tension,motor activity and reflection three dimensions)were tested for infants aged 0 to 1.At 12-month-old(44-52 weeks of correction),different developmental outcomes were determined according to the diagnostic criteria for cerebral palsy.According to the research method of health statistics,the early warning score of 2-month-old general movement features was established.2.In 4-month-old(12 weeks to 16 weeks),the infant's neurological development was evaluated using the 4-month-old general movements overall assessment and refinement score,while the levels of muscular tension,muscular strength and the level of gravity resistance were assessed.3.In 12-month-old(corrected age from 44 weeks to 52 weeks),according to the diagnostic criteria for cerebral palsy,determine the different developmental outcomes.At the same time,the Gesell Developmental Scale was used to test the development quotients of its ability to move,its ability to respond,its speech ability,and its ability to respond.4.Based on the relevant clinical data,a questionnaire was designed by the expert group of the project.The investigation included general conditions of the family,high risk factors for the mother's pregnancy,birth conditions,and high-risk factors at birth.Through single-factor analysis and stepwise regression analysis,high-risk factors related to early warning scores of cerebral palsy general movements were screened in.Results:1.Establishment of early warning score of general movements feature cerebral palsy1.1 114 high-risk infants were assessed by 2-month-old general movements and 52neuromotor examinations.The results showed that the 2-month-old general movements characteristic scores were significantly different in the normal group,the monotonous exercise group,and the synchronous exercise group(X~2=91.070,p<0.001).It also had a positive correlation with 52 sports-related scores,with the correlation coefficient was 0.969,and p<0.001.1.2 According to 12-month-old different motor development outcomes,there was a significant difference in the general movements characteristic score at 2-month-old in the normal motor development group,the backward developmental motor group,and the cerebral palsy group(X~2=76.457,p<0.001).1.3 Based on 12-month-old differential motor development outcomes,a 2-month-old general movements feature of the cerebral palsy warning scoring method was established using the 95%confidence interval of the general movements feature score at 2-month-old.The results showed that the normal motor development group("green area")ranged from27 to 42 points,which is equivalent to more than 27 points.The range of mild abnormalities("yellow area")ranged from 18 to 26 points.The range of severe abnormalities("red area")ranged from 5 to 17 points,which is equivalent to 17 points or less.1.4 The cerebral palsy warning score of this data is the gold standard for the diagnostic criteria of cerebral palsy at the time of 12-month-old.The results showed that the predictive validity was 92.11%,the sensitivity was 100%,the specificity was 90.00%,the positive predictive value was 72.73%,the negative predictive value was 100%,the false positive rate was 10%,and the false negative rate was 0.The cerebral palsy warning score of this data can be used by medical personnel in clinical practice.2.4-month-old follow-up of general movements warning scoreThe results of this data show that the 4-month-old refinement scores of general movements were significantly different in the normal,mildly abnormal,and severely abnormal groups(X~2=90.740,p<0.001).The 4-month-old infants had significant differences in muscle tension levels in the normal group,the mild abnormal group,and the severe abnormal group(X~2=70.275,p<0.001).Muscle strength was significantly different between the normal group and the abnormal group(ie,mild abnormalities and severe abnormalities)(X~2=77.509,p<0.001).There was also a significant difference between the mild abnormal group and the severe abnormal group(X~2=20.727,p<0.001).The anti-gravity movement grading was significantly different in the normal group,mild abnormal group,and severe abnormal group(X~2=144.940,p<0.001).3.The neurological development of general movements early warning scoreAccording to the general movements feature score at the 2-month-old time,the12-month-old baby's motor ability,physical ability,verbal ability,and human ability development quotient were significant differences in the normal group,mild abnormal group,and severe abnormal group.(X~2are 91.085,85.733,75.997,and 81.309,p are all<0.001).4.High risk factors of general movements early warning score4.1 By single factor analysis,among the early warning groups of cerebral palsy,there are no significant risk factors for parental age,parental education level,smoking/passive smokers in pregnancy,gestational diabetes mellitus,gestational hypertension,cesarean section,preterm birth and neonatal hypoxic-ischemic encephalopathy(X~2are 0.373,0.134,0.403,1.713,1.731,3.039,0.004,0.215,5.509,and 4.179,p all>0.05),while intracranial hemorrhage,convulsion,low body weight and asphyxia,are the high risk factors for the early warning score of the general movements of cerebral palsy(X~2are40.482,58.558,7.697 and 55.964,p are all<0.05).4.2 The stepwise regression analysis showed that intracranial hemorrhage,convulsion,low body weight and asphyxia,were also high risk factors for general movements early warning score(t are 4.208,3.799,3.094 and 2.183,p are all<0.05).Conclusion:1.To establish a 2-month-old general movements feature warning score for cerebral palsy infants:This study showed that the pre-warning score for the normal motor development group(“green area”)ranges from 27 to 42 points,which is equivalent to 27points or more.The range of developmental backwardness("yellow area")ranged from 18to 26 points.The cerebral palsy group("red area")is 5 to 17 points,which is equivalent to17 points or less.2.There is a clear correlation between 2-month-old general movements warning scores and 4-month-old motor traits:in other words,the 2-month-old general movements warning score is better,then the 4-month-old refinement score is also better.At the same time,the developmental grade of muscle tension,muscle strength and anti-gravity movement is also superior.3.The different scores of the 2-month-old's general movements are clearly related to the 12-month-old neurodevelopmental assessment:in other words,the higher the general movements characteristic score at 2-month-old,the higher the general movements feature score.4.The risk factors affecting the 2-month-old general movements early warning score are intracranial hemorrhage,convulsions,low body weight and asphyxia,which should be given due attention in clinical practice. |
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