臺灣博碩士論文加值系統

背景與目的：極低出生體重早產兒(出生體重<1,500公克)為動作發展遲緩的高危險族群極需早期評估與介入。過去探討早產兒早期動作發展之文獻多為單一時間點的評估並顯示群體平均的表現，少有探討可能出現次群體之動作發展變化及影響動作發展軌跡的因子。因此，本研究之目的為探究極低出生體重早產兒一歲以前之粗動作發展軌跡、其影響因子以及與日後發展之關聯。方法：本研究包括342位極低出生體重早產兒，收集其周產期與社會環境資料，並於矯正年齡4、6、9及12個月時實施阿爾伯塔嬰幼兒動作量表評估以了解其粗動作發展，及矯正年齡兩歲時實施貝萊氏嬰兒發展量表第二版之評估以了解其神經發展預後。結果：極低出生體重早產兒呈現三種粗動作發展軌跡：持續正常(55%)、逐漸變差(32%)及持續遲緩(13%)。逐漸變差軌跡與低出生體重(勝算比[95%信賴區間] = 1.1 [1.0-1.1])、男孩(勝算比[95%信賴區間] = 2.4 [1.4-3.8])、中重度慢性肺疾病(勝算比[95%信賴區間] = 2.9 [1.7-5.0])明顯相關；持續遲緩軌跡與低出生體重(勝算比[95%信賴區間] = 1.1 [1.0-1.1])、中重度慢性肺疾病(勝算比[95%信賴區間] = 5.1 [2.3-11.4])、第三四度視網膜病變(勝算比[95%信賴區間] = 7.2 [2.6-19.9])及嚴重腦傷(勝算比[95%信賴區間] = 51.5 [6.3-423.4])明顯相關(以上p < 0.05)。此外，逐漸變差軌跡可預測矯正年齡兩歲之動作遲緩(邊緣遲緩勝算比[95%信賴區間] = 3.2 [1.8-5.7]與顯著遲緩勝算比[95%信賴區間] = 20.6 [4.6-92.0])以及認知遲緩(邊緣遲緩勝算比[95%信賴區間] = 2.4 [1.4-4.3]與顯著遲緩勝算比[95%信賴區間] = 6.6 [2.1-20.8)])，而持續遲緩軌跡則可預測矯正年齡兩歲之動作遲緩(邊緣遲緩勝算比[95%信賴區間] = 8.0 [3.3-19.4]與顯著遲緩勝算比[95%信賴區間] = 83.4 [16.1-432.7])以及認知遲緩(邊緣遲緩勝算比[95%信賴區間] = 7.6 [3.0-18.9]與顯著遲緩勝算比[95%信賴區間] = 28.5 [7.8-103.5]) (以上p < 0.05)。結論：極低出生體重早產兒於一歲前之動作發展呈現多樣的軌跡，主要與周產期因子相關，並可預測矯正年齡兩歲之認知與動作發展預後。以上資料可提供早期偵測早產兒動作發展遲緩及接受早期介入之參考。

Background and Purposes: Preterm infants with very low birth weight (VLBW, birth weight < 1,500g) are at risk of motor disorders that require early assessment and intervention. Previous studies on early motor development in preterm infants were mostly based on single time point and have relied on estimation of mean performance that the variation within group over age and the influencing factors were rarely explored. Therefore, the purposes of this study were to examine the developmental trajectories of gross motor function in VLBW preterm infants during the first year of life, to investigate the influencing factors for the motor trajectories, and to investigate the prediction of later neurodevelopmental outcome by early motor trajectories. Methods: A total of 342 VLBW preterm infants were prospectively assessed for their motor function by the Alberta Infant Motor Scales (AIMS) at 4, 6, 9 and 12 months of corrected age, and were examined for the cognitive and motor function by the Bayley Scales of Infant and Toddler Development-2nd edition (BSID-II) at two years of corrected age. Perinatal and socio-environmental factors were also collected. Results: VLBW preterm infants showed three distinct motor developmental trajectories during the first year of life: stably normal (55%), deteriorating (32%), and persistently delayed (13%). The deteriorating pattern was significantly associated with low birth body weight (odds ratio (OR) [95% confidence interval (CI)] = 1.1 [1.0-1.1]), male gender (OR [95% CI]= 2.4 [1.4-3.8]), and moderate/severe bronchopulmonary dysplasia (OR [95% CI]= 2.9 [1.7-5.0]); whereas the persistently delayed pattern was significantly associated with low birth body weight (OR [95% CI]= 1.1 [1.0-1.1]), moderate/severe bronchopulmonary dysplasia (OR [95% CI] = 5.1 [2.3-11.4]), stage III/IV retinopathy of prematurity (OR [95% CI] = 7.2 [2.6-19.9]), and major brain damage (OR [95% CI] = 51.5 [6.3-423.4]) (all p < 0.05). Furthermore, the deteriorating pattern was predictive of motor delay (borderline delay, OR [95% CI] = 3.2 [1.8-5.7]; significant delay, OR [95% CI] = 20.6 [4.6-92.0]) and mental delay (borderline delay, OR [95% CI] = 2.4 [1.4-4.3]; significant delay, OR [95% CI] = 6.6 [2.1-20.8]) at two years of corrected age; whereas the persistently delayed pattern was predictive of motor delay (borderline delay, OR [95% CI] = 8.0 [3.3-19.4]; significant delay, OR [95% CI] = 83.4 [16.1-432.7]) and mental delay (borderline delay, OR [95% CI] = 7.6 [3.0-18.9]; significant delay, OR [95% CI] = 28.5 [7.8-103.5]) at two years of corrected age (all p < 0.05). Conclusion: VLBW preterm infants manifested various motor trajectories throughout the first year of life that were mainly related to perinatal factors and were predictive of later motor and mental outcome. The results provided insightful information for early detection and intervention of motor disorders in VLBW preterm infants.

誌謝……………………………………………………………………………………i
口試委員會審定書……………………………………………………………………ii
摘要………………………………………………………………………………………iii
Abstract…………………………………………………………………………………v
Contents…………………………………………………………………………………vii
Chapter I. Introduction……………………………………………………………………1
1.1 Lifelong consequences of preterm birth with VLBW……………………………1
1.2 Early motor development in VLBW preterm infants……………………………2
1.3 Early assessment of motor function in preterm children…………………………3
1.4 Statistical methods for assessment of motor trajectory patterns…………………3
1.5 Influencing factors for motor development………………………………………5
1.6 Study purposes and hypotheses……………………………………………………7
Chapter II. Method……………………………………………………………………9
2.1 Participants………………………………………………………………………9
2.2 Assessment procedures……………………………………………………………9
2.3 Neurodevelopmental measures……………………………………………………10
2.3.1 Alberta Infant Motor Scale……………………………………………………10
2.3.2 Bayley Scales of Infant and Toddler Development-2nd Edition……………11
2.4 Statistical analysis………………………………………………………………13
Chapter III. Results……………………………………………………………………17
3.1 Study Sample……………………………………………………………………17
3.2 Gross motor development at 4, 6, 9, and 12 months of age………………………17
3.3 Model selection for motor trajectories……………………………………………18
3.4 Developmental trajectories of gross motor function in VLBW infants……………19
3.5 Influencing factors associated with motor trajectories during the first year of life………………………………………………………………………………………20
3.6 Prediction of neurodevelopmental outcome at two years of corrected age from motor trajectories during the first year of life…………………………………………21
Chapter IV. Discussion……………………………………………………………….22
Chapter V. Conclusion…………………………………………………………………27
Chapter VI. Acknowledgement………………………………………………………28
Tables and Figures……………………………………………………………………29
References……………………………………………………………………………42
Appendix………………………………………………………………………………55

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