Öz
Amaç: Bu çalışmada yüksek riskli bebeklerde iki yaşında serebral palsi (SP) tanısı için genel hareket değerlendirmesi (GMA), Hammersmith infant nörolojik muayene (HINE) ve bebek duyusal profili-2’nin (ISP-2) prediktif değerleri araştırıldı.
Yöntemler: Yenidoğan yoğun bakım ünitesinden taburcu olduktan sonra fizyoterapi ünitesinde takip edilen, ortalama gebelik yaşı 33,1±4,2 olan 34 yüksek riskli bebek çalışmaya alındı. Bebekler için demografik veriler, doğum öncesi risk faktörleri ve üçüncü ayda Prechtl’in GMA sonuçları toplandı. Nörolojik muayene ve duyusal işlemeyi değerlendirmek için sırasıyla HINE ve ISP-2 anketi üçüncü ayda bir kez yapıldı. GMA, HINE ve ISP-2’nin prediktif değerleri sıralı (tek-iki-üç aşamalı) değerlendirildi.Tüm testlere kör olan bir pediatrik nörolog, nörogörüntüleme ve klinik testlere dayanarak iki yaşında SP tanısını koydu.
Bulgular: Bebeklerin ortalama doğum ağırlığı 1993,7±889,3 gram (gr), 3. ay ve sırasıyla HINE ve ISP-2 toplam puan ortalamaları 56,9±9.3 ve 53,8±13 idi. SP tanısı koymak için GMA (FM olmaması) (sensitivite: %100; spesifite: %96,15, p<0,001; %95 güven aralığı: 80,36-99,9), HINE’nin (sensitivite: 87,5 spesifite: %80,77; p=0,004) ya da GMA ile HINE kombinasyonunun (sensitivite: %87,5; spesifite: %100; p<0,001) prediktif değerlerinin yüksek olduğu, ISP-2, GMA ve HINE kombinasyonunun sensitivite: %62,5, spesifite: %100, p=0,002), ISP-2’nin tek kullanıldığında dikkat çeken prediktif performansına rağmen sensitivite: %75, spesifite: %61,54, p=0,123) SP tanısını belirlemede anlamlı olduğu bulundu.
Sonuç: Yüksek riskli bebeklerin takibiyle SP’nin erken tanısının; klinik uygulama, GMA ve HINE kombinasyonuyla yapılması erken müdahaleye yönlendirmeye olanak sağlayabilir.
Anahtar Kelimeler: Genel hareket değerlendirmesi, Hammersmith bebek nörolojik muayenesi, bebek duyu profili-2, serebral palsi, yüksek riskli bebek
Kaynakça
Pascal A, Govaert P, Oostra A, Naulaers G, Ortibus E, Van den Broeck C. Neurodevelopmental outcome in very preterm and very-low-birthweight infants born over the past decade: a meta-analytic review. Dev Med Child Neurol. 2018;60:342-55.
Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2013;55:509-19.
Li W, Peng A, Deng S, Lai W, Qiu X, Zhang L, et al. Do premature and postterm birth increase the risk of epilepsy? An updated meta-analysis. Epilepsy Behav. 2019;97:83-91.
Wiingreen R, Greisen G, Svensson J, Hansen BM. Low gestational age at birth and difficulties in school-A matter of ‘dose’. PLoS One. 2018;13:e0198482.
Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA Pediatr. 2017;171:897-907.
Einspieler C, Marschik PB, Bos AF, Ferrari F, Cioni G, Prechtl HF. Early markers for cerebral palsy: insights from the assessment of general movements. Future Neurol. 2012;7:709-17.
Yiğit S, Kerem M, Livanelioğlu A, Oran O, Erdem G, Mutlu A, et al. Early physiotherapy intervention in premature infants. Turk J Pediatr. 2002;44:224-9.
Vogel JP, Chawanpaiboon S, Moller AB, Watananirun K, Bonet M, Lumbiganon P. The global epidemiology of preterm birth. Best Pract Res Clin Obstet Gynaecol. 2018;52:3-12.
Spittle AJ, Cheong J, Doyle LW, Roberts G, Lee KJ, Lim J, et al. Neonatal white matter abnormality predicts childhood motor impairment in very preterm children. Dev Med Child Neurol. 2011;53:1000-6.
Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14.
Morgan C, Romeo DM, Chorna O, Novak I, Galea C, Del Secco S, et al. The pooled diagnostic accuracy of neuroimaging, general movements, and neurological examination for diagnosing cerebral palsy early in high-risk infants: a case control study. J Clin Med. 2019;8:1879.
King AR, Machipisa C, Finlayson F, Fahey MC, Novak I, Malhotra A. Early detection of cerebral palsy in high-risk infants: Translation of evidence into practice in an Australian hospital. J Paediatr Child Health 2021;57:246-50.
Einspieler C, Peharz R, Marschik PB. Fidgety movements - tiny in appearance, but huge in impact. J Pediatr (Rio J). 2016;92(3 Suppl):64-70.
Romeo DM, Ricci D, Brogna C, Mercuri E. Use of the Hammersmith Infant Neurological Examination in infants with cerebral palsy: a critical review of the literature. Dev Med Child Neurol. 2016;58:240-5.
Kwong AKL, Fitzgerald TL, Doyle LW, Cheong JLY, Spittle AJ. Predictive validity of spontaneous early infant movement for later cerebral palsy: a systematic review. Dev Med Child Neurol. 2018;60:480-9.
Einspieler C, Prechtl HF. Prechtl’s assessment of general movements: a diagnostic tool for the functional assessment of the young nervous system. Ment Retard Dev Disabil Res Rev. 2005;11:61-7.
Kara OK, Sahin S, Kara K, Arslan M. Neuromotor and sensory development in preterm infants: prospective study. Turk Arch Pediatr. 2020;55:46-56.
Dunn W. Sensory Profile 2 Manual. San Antonio, TX.: Pearson Clinical Assessment,; 2014.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946355/
Yardımcı-Lokmanoğlu BN, Mutlu A, Livanelioğlu A. The early spontaneous movements, and developmental functioning and sensory processing outcomes in toddlers born preterm: A prospective study. Early Hum Dev. 2021;163:105508.
Backhouse M, Harding L, Rodger S, Hindman N. Investigating sensory processing patterns in boys with Duchenne muscular dystrophy using the Sensory Profile. Br J Occup Ther. 2012;75:271-80.
Celik HI, Elbasan B, Gucuyener K, Kayihan H, Huri M. Investigation of the relationship between sensory processing and motor development in preterm infants. Am J Occup Ther. 2018;72:7201195020p1-p7.
Machado ACCP, Oliveira SR, Magalhães LC, Miranda DM, Bouzada MCF. Sensory processing during childhood in preterm infants: a systematic review. Rev Paul Pediatr. 2017;35:92-101.
Eeles AL, Spittle AJ, Anderson PJ, Brown N, Lee KJ, Boyd RN, et al. Assessments of sensory processing in infants: a systematic review. Dev Med Child Neurol. 2013;55:314-26.
Germani T, Zwaigenbaum L, Bryson S, Brian J, Smith I, Roberts W, et al. Brief report: assessment of early sensory processing in infants at high-risk of autism spectrum disorder. J Autism Dev Disord. 2014;44:3264-70.
Romeo DM, Cioni M, Scoto M, Pizzardi A, Romeo MG, Guzzetta A. Prognostic value of a scorable neurological examination from 3 to 12 months post-term age in very preterm infants: a longitudinal study. Early Hum Dev. 2009;85:405-8.
Kayihan HM, Kose B, Temizkan E, Kars S. Cultural Adaptation, adaptation, validity and reliability of the Turkish version of infant sensory profile 2 in preterm infants. 1st International Congress of Early Intervention and Rehabilitation; 2018; Ankara, Turkey. Gazi University Journal of Health Sciences.
Ashwal S, Russman BS, Blasco PA, Miller G, Sandler A, Shevell Met al. Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2004;62:851-63.
Cabral TI, da Silva LG, Martinez CM, Tudella E. Analysis of sensory processing in preterm infants. Early Hum Dev. 2016;103:77-81.
Prechtl HF, Einspieler C, Cioni G, Bos AF, Ferrari F, Sontheimer D. An early marker for neurological deficits after perinatal brain lesions. Lancet. 1997;349:1361-3.
Romeo DM, Cioni M, Scoto M, Mazzone L, Palermo F, Romeo MG. Neuromotor development in infants with cerebral palsy investigated by the Hammersmith Infant Neurological Examination during the first year of age. Eur J Paediatr Neurol. 2008;12:24-31.
Adıgüzel H, Sarıkabadayı YÜ, Apaydın U, Katırcı Kırmacı Zİ, Gücüyener K, Günel Karadeniz P, et al. Turkish Validity and Reliability of the Hammersmith Infant Neurological Examination (HINE) with High-Risk Infant Group: A Preliminary Study. Turk Arch Pediatr. 2022;57:151.
Smith GC, Gutovich J, Smyser C, Pineda R, Newnham C, Tjoeng TH, et al. Neonatal intensive care unit stress is associated with brain development in preterm infants. Ann Neurol 2011;70:541-9.
Chorna O, Solomon JE, Slaughter JC, Stark AR, Maitre NL. Abnormal sensory reactivity in preterm infants during the first year correlates with adverse neurodevelopmental outcomes at 2 years of age. Arch Dis Child Fetal Neonatal Ed. 2014;99:475-9.
Eeles AL, Anderson PJ, Brown NC, Lee KJ, Boyd RN, Spittle AJ, et al. Sensory profiles obtained from parental reports correlate with independent assessments of development in very preterm children at 2 years of age. Early Hum Dev. 2013;89:1075-80.
Bart O, Shayevits S, Gabis LV, Morag I. Prediction of participation and sensory modulation of late preterm infants at 12 months: a prospective study. Res Dev Disabil. 2011;32:2732-8.
