ハイリスク新生児の評価

Abstract

In spite of the advancement of neonatology over the past 25 years, neonatal neurological deficits still occur. Rehabilitation professionals are required to assess neonatal neurological status and screen high risk infants. The indicators to predict developmental outcomes of the high risk infants in the neonatal periods are; 1) perinatal risk factors, 2) neurological examination, 3) general movements, and 4) neurobehavioral assessment. Severe complications of the central nervous system are risk factors for major neurologic problems. Particularly, periventricular leukomalacia and periventricular hemorrhage are significant predictors of subsequent cerebral palsy. Ultrasound brain scan, CT and MRI have helped in the non-invasive detection of brain damage in young preterm infants. Social class is related to problems in the primary school. The traditional neurological examination consists of the grading of the state, muscle tonus, posture, spontaneous movements, reflexes, and other neurological abnormalities such as neonatal seizures, repeated apnea, oral-motor dysfunction, or high-pitched cry. Qualitative assessment of general movement has been shown to be a good predictor of neurologic outcome in high risk preterm infants. Brazelton Neonatal Behavioral Assessment Scale combines both behavioral and neurological approaches. The following points should be kept in mind when assessing infants in the neonatal period. 1) To predict subsequent disabilities, we must consider findings of various assessment methods comprehensively. 2) The assessment should be designed to be easy, reliable, and non-invasive. 3) Children must be followed up at least until they enter primary schools.