The Applicability Of Dubowitz Neurological Assessment In Neonates

Objective Based on the relatively immature development of nervous system and the current situation of relatively neglect of late-preterm and early term neonates,this study examines the reliability and correlation of Dubowitz neurological assessment(The Neurological Assessment of the Preterm and Full-term Newborn Infant-Second edition)in late-preterm neonates and early term neonates,in order to evaluate the feasibility of its utility in China,and to provide clues for early screening and intervention for late-preterm and early term neonates.Method(1)Between October 2016 and February 2017,307 low risk neonates(including 164 late-preterm and 143 early-term neonates)born in Shanghai First Maternity and Infant Hospital were selected and tested with Dubowitz neurological assessment within 6 hours after birth(retested 3 days later and the premature infants were tested again at corrected gestational age of 40 weeks according to the manual.).The Cronbach alpha coefficient was used to examine the internal consistency of each dimension.The Intra-class Coefficient(ICC)was used to analyze the inter-rater and test-retest consistency.(2)The above 307 infants were included in the follow-up cohort.BSID-?(Bayley Scale of Infant Development-3rd Edition,BSID-?)were performed at 6-month age(calculate corrected age for preterm infants).The Pearson Correlation Coefficient was used to test the correlation of Dubowitz neurological assessment and the neuro development level 6 months.Results(1)The analysis of reliability in LPI within 6 hours after birth and at corrected gestational age of 40 weeks: The Cronbach's ?coefficient of total score,posture and tone and motor was 0.715~0.850(p<0.01),suggested good external reliability.The Inter-rater ICC was from 0.795 to 0.850 and suggested good inter-rater reliability.The ICC coefficients of tone patterns,reflex,abnormal signs and direction and behavior dimensions were from 0.658 to 0.733 and showed good test-retest reliability.(2)The analysis of reliability in ETI within 6 hours after birth: The Cronbach's ? coefficient of total score,posture and tone,motor dimensions were between 0.624~0.756(p<0.01)and suggested moderate to good internal consistency.The Inter-rater ICC was from 0.888 to.991(p<0.01),showed excellent inter-rater reliability.The test-retest ICC of tone patterns,reflex,motor and direction and behavior dimensions were from 0.691 to 0.999(p<0.01)and suggested good test-rest reliability.The test-retest ICC of abnormal signs dimension was 0.577(p<0.05)and showed generally acceptable test-rest reliability.(3)Correlation of neurological-behavioral development of 6-month age: In LPI,there are significant correlations between the abnormal signs and corrected 6-month cognitive and motor composite scores(p<0.05),there are negative correlations between posture and tone and cognitive DQ of corrected 6-month(p<0.05).The scores of posture and tone,reflex and motor of preterm infants at corrected term age are partially and the abnormal signs are negatively correlated with cognitive composite score of corrected 6-month(p<0.05).In ETI,the total score,posture and tone and abnormal signs are significantly correlated with cognitive DQ of 6-month.Conclusions(1)The internal reliability of total score,posture and tone and motor dimensions were moderate to excellent.The overall inter-rater reliability was good.The test-retest reliability was not optimal because of the rapid development and various change of the neurological system.The results need to be further verified by shortening the retest time and expanding the sample size.(2)The Dubowitz neurological assessment has a certain predictive value of infancy neurological-behavioral level in LPI at corrected gestational age of 40 weeks and ETI within 6 hours after birth.It is of good guiding significance for the early screening and monitoring of LPI and ETI who have relatively backward development of nervous system.