早産児における Dubowitz 神経学的評価の特徴 : 脳障害児との比較

低出生体重児57名と,新生児期に明らかな脳障害が確認された11名を対象に,出産予定日頃にDubowitz の神経学的評価を行った.発達に影響を及ぼす因子として報告されている,在胎週数,出生体重を考慮し,評価結果の比較検討を行った.評価したすべてのカテゴリーとtotal score において低出生体重児では早産・低体重の程度による影響を受けず,出産予定日での発達に差はなかった.tone,reflexes,behavior のカテゴリーでは早産児は脳障害児のスコアと比べて有意に高かった.また,tone patterns,abnormal signs では早産児と脳障害児でスコアに違いはみられず,このカテゴリーにおいて異常性との判別は難しいと考えられる.total score でみると早産児のスコアはDubowitz により報告されたカットオフ値の30 より低いスコアであり,低出生体重児での新たな基準を設定する必要が示唆された.

Fifty-seven preterm infants and eleven infants in whom neonatal encephalopathy had been confirmed were examined by Dubowitz neurologic examination at term age. The results were compared based on their gestational age and birthweight, both of which are reported as factors which influence development. No influence of premature delivery and low weight was seen in preterm infants in the evaluated total score of the Dubowitz neurologic examination, and there was no difference in development at term age. There were significant differences in the scores in the categories of tone, reflexes, and behavior in the preterm infants compared with the neonatal encephalopathy infants. Moreover, no difference was seen in the score of the preterm infants and the neonatal encephalopathy infants in tone patterns and abnormal signs. Therefore, it is difficult to distinguish premature infants from abnormal infants in these categories. In this study, the total score reported by Dubowitz for preterm infants was lower than that for full-term infants, and the necessity for establishing a new standard for preterm infants is proposed.