Journal of paediatrics and child health最新文献_第6页

Secondary prophylaxis and specialist review compliance in paediatric patients with acute rheumatic fever and rheumatic heart disease in a Western Australian metropolitan setting 西澳大利亚大都市急性风湿热和风湿性心脏病儿科患者的二级预防和专科复查依从性。

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health

Pub Date : 2024-09-21 DOI: 10.1111/jpc.16670

Adrian Tarca, Jennifer Melvin, Bradley MacDonald, Ahilan Jeyaseelan, James Ramsay, Stephen Shipton, Julie Vine, Deane Yim

Aim

Rheumatic heart disease (RHD), a consequence of acute rheumatic fever (ARF), continues to cause significant morbidity and mortality in susceptible young people. Secondary antibiotic prophylaxis is an effective strategy to prevent ARF recurrence and RHD progression. However, the proportion of patients receiving the recommended minimum benzathine penicillin injections (>80%) remains low. This retrospective cohort study reviews the utility of the Hospital in the Home nursing service in providing secondary prophylaxis for outpatients in a metropolitan state capital.

Methods

Fifty-eight patients with ARF/RHD receiving secondary prophylaxis through the Hospital in the Home service between 1 July 2012 and 30 June 2020 were included. Compliance of secondary prophylaxis, specialist review and echocardiogram frequency were compared against the recommendations from the Australian RHD guidelines.

Results

Forty-six (79%) patients received >80% of recommended doses, with 36% (n = 21) receiving 100% and a further 29% (n = 17) achieving compliance of 90%–99%. We found that 35% of patients attended all specialist reviews (including echocardiography) at the recommended frequency, with 75% of those not attending all reviews, missing only one or two appointments. Compliance was greater in those with more severe disease. In the 12 (21%) patients who did not meet the >80% target, compliance ranged between 33% and 79% (mean 64.5%) and all had priority 3 disease.

Conclusion

Community-based administration of secondary prophylaxis through a registry-based system is an effective strategy of improving compliance within a metropolitan area and should be utilised in a culturally safe and collaborative manner to increase uptake.

目的：风湿性心脏病（RHD）是急性风湿热（ARF）的一种后遗症，在易感年轻人中继续造成严重的发病率和死亡率。二次抗生素预防是防止急性风湿热复发和风湿性心脏病恶化的有效策略。然而，接受推荐的最低苄星青霉素注射的患者比例（>80%）仍然很低。这项回顾性队列研究回顾了家庭医院护理服务在为大都会州首府门诊患者提供二级预防治疗方面的效用：研究纳入了 2012 年 7 月 1 日至 2020 年 6 月 30 日期间通过 "居家医院 "服务接受二级预防治疗的 58 名 ARF/RHD 患者。结果：46例（79%）患者接受了二次预防治疗，专家复查和超声心动图检查的频率与澳大利亚RHD指南的建议进行了比较：46名患者（79%）接受了超过80%的推荐剂量，其中36%（21人）接受了100%的剂量，另有29%（17人）达到了90%-99%。我们发现，35% 的患者按建议频率参加了所有专科复查（包括超声心动图检查），75% 的患者未参加所有复查，仅错过了一次或两次预约。病情较重的患者的依从性更高。在12名（21%）未达到80%以上目标的患者中，依从性介于33%和79%之间（平均为64.5%），所有患者均患有3级疾病：通过以登记为基础的系统在社区进行二级预防是在大都市地区提高依从性的有效策略，应该以文化安全和合作的方式加以利用，以提高依从性。

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引用次数: 0

Using latent variable modelling to identify etiological heterogeneity in preterm delivery 利用潜在变量模型确定早产的病因异质性。

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health

Pub Date : 2024-09-21 DOI: 10.1111/jpc.16660

Kim Steven Betts, Rosa Alati, Peter Baker

Aims

To identify a subgroup of mothers at high risk of preterm delivery, defined by empirical classes of multimorbidity and recurrence across three consecutive births.

Methods

The data were extracted from the perinatal data collection (PDC) of all inpatient live births (n = 435 912) occurring in the Australian state of Queensland between January 2009 and December 2015. Within this data, a total of 7714 primiparous mothers delivered three consecutive singleton live births (total births = 23 142), and comprise the sample for all analyses.

Results

The LCA indicated a four-class solution fit the data best at each time point, including (i) a ‘normative’ or healthy class with little morbidity (including >80% of the sample at each birth); (ii) a preterm, high morbidity class (<2% of the sample); (ii) a delivery morbidity class (4–8% of the sample); and (iii) preterm, low morbidity class (5–6% of the sample). Each group exhibited unique and consistent associations with maternal and pregnancy-related factors across births. After accounting for these factors, the high morbidity class and preterm, low morbidity class strongly predicted these same classes across consecutive births, and from birth 1 to birth 3 (second-order transition).

Conclusions

A small but highly morbid class of neonatal deliveries emerged, exhibiting strong continuity across consecutive births (odds ratios >10), independent of a range of maternal and pregnancy-related factors. This group of women, if subject to further investigation, could provide valuable insight into the aetiology of prematurity and associated morbidity, perhaps providing information to improve birth outcomes among all women.

目的：确定早产高风险母亲亚群，该亚群由多病和连续三次分娩复发的经验类别界定：数据来自围产期数据收集（PDC），收集了2009年1月至2015年12月期间澳大利亚昆士兰州所有住院活产婴儿（n = 435 912）的数据。在这些数据中，共有7714名初产妇连续分娩了三胎单胎活产（总出生人数=23 142），她们构成了所有分析的样本：生命周期分析表明，在每个时间点，四类解决方案最适合数据，包括：(i) "正常 "或健康类，发病率低（包括每次分娩中超过 80% 的样本）；(ii) 早产、高发病率类（结论：早产、高发病率类是一个很小但发病率很高的类：出现了一个规模小但发病率高的新生儿分娩群体，该群体在连续分娩中表现出很强的连续性（几率比大于 10），不受一系列产妇和妊娠相关因素的影响。如果对这部分产妇进行进一步调查，就能深入了解早产的病因和相关发病率，从而为改善所有产妇的分娩结果提供信息。

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引用次数: 0

Incidence and presenting features of paediatric type 1 diabetes mellitus and diabetic ketoacidosis in a regional Australian health service 澳大利亚一个地区医疗服务机构中儿科 1 型糖尿病和糖尿病酮症酸中毒的发病率和表现特征。

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health

Pub Date : 2024-09-19 DOI: 10.1111/jpc.16673

Shaun Cousen, Matthew Hiskens, Dana Signal, Venkat Vangaveti, Gopakumar Hariharan

Aim

To determine the incidence and presenting features of type 1 diabetes mellitus and diabetic ketoacidosis in a paediatric population serviced by a regional health service in Queensland, Australia.

Methods

All patients less than 16 years old diagnosed with type 1 diabetes mellitus between 01 January 2015 and 31 December 2021 were included in this retrospective, observational study. The electronic medical records of each patient were reviewed to collect data on demographics, presentation and ongoing diabetes care.

Results

Sixty-four paediatric patients were diagnosed with type 1 diabetes mellitus during the study period, giving an incidence of 25 cases per 100 000 person years. Half the patients presented with diabetic ketoacidosis, with 14 (22% of the total cohort) presenting in severe diabetic ketoacidosis. There was no significant increase in the incidence of type 1 diabetes mellitus or proportion of patients with diabetic ketoacidosis across the years of the study. Patients that had a delayed diagnosis had an increased likelihood of presenting with severe diabetic ketoacidosis.

Conclusion

Incidence of type 1 diabetes mellitus in the paediatric population in this regional centre in Queensland, Australia, is similar to national data. High proportions of patients presenting with diabetic ketoacidosis and severe diabetic ketoacidosis were identified in the study population, with delayed diagnosis, a risk factor for severe diabetic ketoacidosis.

目的：确定澳大利亚昆士兰州地区医疗服务机构服务的儿科人群中 1 型糖尿病和糖尿病酮症酸中毒的发病率和表现特征：这项回顾性观察研究纳入了 2015 年 1 月 1 日至 2021 年 12 月 31 日期间确诊为 1 型糖尿病的所有 16 岁以下患者。研究人员查阅了每位患者的电子病历，以收集有关人口统计学、发病情况和持续糖尿病护理的数据：研究期间，64 名儿童患者被诊断为 1 型糖尿病，发病率为每 10 万人年 25 例。半数患者出现了糖尿病酮症酸中毒，其中 14 人（占总人数的 22%）出现了严重的糖尿病酮症酸中毒。在整个研究期间，1 型糖尿病的发病率和糖尿病酮症酸中毒患者的比例都没有明显增加。延迟诊断的患者出现严重糖尿病酮症酸中毒的可能性增加：结论：在澳大利亚昆士兰州的这个地区中心，1 型糖尿病在儿科人群中的发病率与全国数据相似。在研究人群中发现，出现糖尿病酮症酸中毒和严重糖尿病酮症酸中毒的患者比例很高，其中诊断延迟是导致严重糖尿病酮症酸中毒的一个风险因素。

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引用次数: 0

Examination of the relationship between ABO/Rh blood groups and dietary compliance in children with coeliac disease: A single-centre experience 研究 ABO/Rh 血型与乳糜泻患儿饮食依从性之间的关系：单中心经验。

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health

Pub Date : 2024-09-19 DOI: 10.1111/jpc.16674

Sibel Yavuz, Metin Çil, Mehmet Turgut

Aim

Coeliac disease (CD) is an autoimmune enteropathy that develops upon ingestion of food containing gluten. The established link between ABO blood groups and numerous infectious and non-infectious illnesses prompted this investigation into blood group distribution and its relationship with dietary compliance among children diagnosed with CD.

Methods

In this retrospective study, patients with CD who were followed for ≥1 year at the paediatric gastroenterology outpatient clinic of our hospital were evaluated. History, physical examination and coeliac serology results were reviewed for each patient. Patients were divided into two groups based on self-reported compliance to a gluten-free diet: diet-adherent and non-diet-adherent. Patient and control groups were examined in terms of ABO blood groups.

Results

A total of 177 patients with CD were included in the study. A control group of 211 age- and sex-matched children without any chronic disease who had undergone blood group testing for various reasons was included for comparison. A total of 65% (n = 115) of the patients were girls, and 35% (n = 62) were boys. No significant relationship was found between CD diagnosis and ABO blood groups among patients (P = 0.559). Furthermore, the dietary compliance status of the patients was not associated with any specific blood group (P = 0.951).

Conclusion

No notable difference was found between patients with CD with or without gluten-free diet compliance in terms of the distribution of ABO blood groups and Rhesus (Rh) factor. Therefore, it can be inferred that all blood groups and subgroups carry an equal risk for CD.

目的：乳糜泻（CD）是一种自身免疫性肠病，因摄入含有麸质的食物而发病。ABO 血型与多种感染性和非感染性疾病之间的联系已被证实，这促使我们对血型分布及其与被确诊为 CD 的儿童的饮食依从性之间的关系进行调查：在这项回顾性研究中，我们对本院儿科胃肠病门诊随访≥1年的CD患者进行了评估。研究人员回顾了每位患者的病史、体格检查和乳糜泻血清学检查结果。根据患者自述的无麸质饮食依从性将其分为两组：依从饮食组和非依从饮食组。对患者组和对照组进行了 ABO 血型检查：研究共纳入了 177 名 CD 患者。对照组包括 211 名年龄和性别相匹配、未患任何慢性疾病的儿童，他们都曾因各种原因接受过血型检测。共有 65% 的患者（n = 115）是女孩，35% 的患者（n = 62）是男孩。CD 诊断与患者的 ABO 血型无明显关系（P = 0.559）。此外，患者的饮食依从性与任何特定血型均无关联（P = 0.951）：结论：在符合或不符合无麸质饮食的 CD 患者中，ABO 血型和恒河猴（Rh）因子的分布没有明显差异。因此，可以推断所有血型和亚型患 CD 的风险相同。

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引用次数: 0

Near-occlusive ductal thrombus extending to abdominal aorta in neonate: Recovery with thrombectomy 新生儿近闭塞性导管血栓延伸至腹主动脉：血栓切除术后康复。

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health

Pub Date : 2024-09-19 DOI: 10.1111/jpc.16672

Imran Syed, Arashk Ghasroddashti, Tapas Mondal, Vinay Kukreti

引用次数: 0

Neonatal vein of Galen malformation: A rare cause of high-output heart failure 新生儿盖伦静脉畸形：高输出性心力衰竭的罕见病因

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health

Pub Date : 2024-09-18 DOI: 10.1111/jpc.16669

Inês Gameiro, Ana Moura Figueiredo, Henrique Queirós, Ricardo Veiga, Egídio Machado, Teresa Dionísio

引用次数: 0

Risk of depression in patients with atopic dermatitis: An updated systematic review and meta-analysis of children, adolescent and adult groups 特应性皮炎患者患抑郁症的风险：针对儿童、青少年和成人群体的最新系统综述和荟萃分析

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health

Pub Date : 2024-09-17 DOI: 10.1111/jpc.16668

Lihua Cao, Jiangwei Su, Fang Tian, Yang Zhou, Songchun Liu, Fanglu Lou

Aim

Atopic dermatitis is a popular allergy disease among children, adolescents and adults. The risk of depression in patients with atopic dermatitis can be evaluated using an updated systemic review and meta-analysis of observational and cross-sectional studies.

Methods

The log odds ratio (OR) was transformed using the OR and 95% confidence interval (CI) to assess the risk of depression in patients with atopic dermatitis across the children, adolescent and adult groups. After a restricted selection, 39 studies of 234 306 patients with atopic dermatitis and 10 935 459 reference individuals were enrolled. The focused outcome was the OR and 95% CI of depression risk in each included study, assigned according to the age for the children, adolescent and adult groups.

Results

In adult patients with atopic dermatitis, a significantly higher risk of depression was observed. In addition, the similar significantly higher risk of depression was observed in children and adolescent patients with atopic dermatitis, respectively. However, the significantly high heterogeneity was observed across children, adolescent and adult groups.

Conclusions

In the current meta-analysis, the patients with atopic dermatitis had a higher risk of depression across the children, adolescent and adult groups, respectively. However, substantial heterogeneity should be considered during the interpretation of our meta-analysis results.

目的特应性皮炎是儿童、青少年和成人中常见的过敏性疾病。通过对观察性研究和横断面研究进行最新的系统回顾和荟萃分析，可以评估特应性皮炎患者患抑郁症的风险。方法使用OR和95%置信区间（CI）转换对数赔率（OR），评估儿童、青少年和成人特应性皮炎患者患抑郁症的风险。经过筛选，39 项研究共纳入了 234 306 名特应性皮炎患者和 10 935 459 名参照个体。重点结果是每项纳入研究的抑郁风险 OR 和 95% CI，根据儿童、青少年和成人组的年龄进行分配。此外，在儿童和青少年特应性皮炎患者中也分别观察到了类似的明显较高的抑郁风险。结论在当前的荟萃分析中，异位性皮炎患者在儿童、青少年和成人组中的抑郁风险都较高。然而，在解释我们的荟萃分析结果时应考虑到严重的异质性。

{"title":"Risk of depression in patients with atopic dermatitis: An updated systematic review and meta-analysis of children, adolescent and adult groups","authors":"Lihua Cao, Jiangwei Su, Fang Tian, Yang Zhou, Songchun Liu, Fanglu Lou","doi":"10.1111/jpc.16668","DOIUrl":"10.1111/jpc.16668","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Atopic dermatitis is a popular allergy disease among children, adolescents and adults. The risk of depression in patients with atopic dermatitis can be evaluated using an updated systemic review and meta-analysis of observational and cross-sectional studies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The log odds ratio (OR) was transformed using the OR and 95% confidence interval (CI) to assess the risk of depression in patients with atopic dermatitis across the children, adolescent and adult groups. After a restricted selection, 39 studies of 234 306 patients with atopic dermatitis and 10 935 459 reference individuals were enrolled. The focused outcome was the OR and 95% CI of depression risk in each included study, assigned according to the age for the children, adolescent and adult groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In adult patients with atopic dermatitis, a significantly higher risk of depression was observed. In addition, the similar significantly higher risk of depression was observed in children and adolescent patients with atopic dermatitis, respectively. However, the significantly high heterogeneity was observed across children, adolescent and adult groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In the current meta-analysis, the patients with atopic dermatitis had a higher risk of depression across the children, adolescent and adult groups, respectively. However, substantial heterogeneity should be considered during the interpretation of our meta-analysis results.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"60 11","pages":"640-647"},"PeriodicalIF":1.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nutritional assessment of under-three years children availing Anganwadi services from rural areas of Puducherry, India 对印度普杜切里农村地区接受 Anganwadi 服务的三岁以下儿童进行营养评估。

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health

Pub Date : 2024-09-16 DOI: 10.1111/jpc.16664

Govindaraj Rajendran, Premkumar Ramasubramani, Sathish Rajaa, Sindhu Kanagalingam, Pediredla Karunakar

Aim

Undernurition stands as a significant contributor to childhood mortality, particularly in developing nations such as India. At the grass root level, anthropometric monitoring indicators such as stunting, underweight and wasting take place within Anganwadi centres (village courtyard). The scrutiny of growth records, utilising these markers, not only quantifies the burden but also informs corrective measures. This study aimed to assess the prevailing growth monitoring records within the rural vicinity of Puducherry.

Methods

A community-based cross-sectional study design was implemented to examine the health condition of children below 3 years of age, who were enrolled and utilising services in Anganwadi centres. The anthropometric data, such as weight and height, were collected from growth monitoring records maintained in Anganwadi. The proportions of undernutrition indicators such as stunting, underweight and wasting were presented with a 95% confidence interval (CI).

Results

Within our rural service area encompassing 13 Anganwadis, a total of 572 children aged 3 or less were registered. Notably, approximately 14.2% (95% CI: 11.5–17.3) of these children experienced underweight, 16.4% (95% CI: 13.6–19.7) were stunted and 13.3% (95% CI: 10.8–16.3) were wasted. In terms of gender disparities, the prevalence of undernurition was notably higher among boy children, with 15.4% being underweight, 16.9% stunted and 14.7% wasted.

Conclusions

The prevalence of childhood undernurition is a public health concern, demanding the enhancement of existing nutritional initiatives to ameliorate the healthy well-being of these children. The timely identification of malnourished children holds paramount importance, as intensified interventions can be promptly employed to uplift the health status of these vulnerable individuals.

目的：未足月是导致儿童死亡的一个重要因素，尤其是在印度等发展中国家。在基层，Anganwadi 中心（乡村庭院）对发育迟缓、体重不足和消瘦等人体测量指标进行监测。利用这些指标对生长记录进行检查，不仅能量化负担，还能为采取纠正措施提供信息。本研究旨在评估普杜切里附近农村地区普遍存在的生长监测记录：方法：采用基于社区的横断面研究设计，检查在 Anganwadi 中心注册并使用服务的 3 岁以下儿童的健康状况。体重和身高等人体测量数据来自 Anganwadi 的成长监测记录。结果显示，发育迟缓、体重不足和消瘦等营养不良指标的比例与 95% 的置信区间 (CI) 相吻合：在我们的农村服务区（包括 13 个 Anganwadis）中，共有 572 名 3 岁或 3 岁以下的儿童进行了登记。值得注意的是，这些儿童中约有 14.2%（95% 置信区间：11.5-17.3）体重不足，16.4%（95% 置信区间：13.6-19.7）发育迟缓，13.3%（95% 置信区间：10.8-16.3）消瘦。在性别差异方面，男孩的尿量不足发生率明显更高，15.4%的男孩体重不足，16.9%的男孩发育迟缓，14.7%的男孩消瘦：儿童尿量不足是一个公共卫生问题，需要加强现有的营养措施，以改善这些儿童的健康状况。及时发现营养不良儿童至关重要，因为可以及时采取强化干预措施，改善这些弱势儿童的健康状况。

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引用次数: 0

The gradient of social determinants of health and related inequalities and early childhood development: Analysis of two rounds of a cross-sectional survey 健康的社会决定因素和相关不平等现象与幼儿发展的梯度：对两轮横断面调查的分析

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health

Pub Date : 2024-09-12 DOI: 10.1111/jpc.16667

M Mofizul Islam

Aim

Social determinants of health (SDH) have a critical role in child development. Yet these determinants are often overshadowed. This study examines the effect of composites of five SDH on early childhood development (ECD) of children of age 36–59 months.

Methods

We used two 2013 and 2019 rounds of Multiple Indicator Cluster Survey Bangladesh data. The analytical sample included ECD data for 25 721 children. ECD was computed following United Nations International Children's Emergency Fund's psychometric approach. Three composite indices of SDH were developed to examine their gradient effects on ECD. Poisson regression with robust variance was used to examine the relationship between SDH indices and ECD. The concentration index was computed, and a concentration curve was developed to measure inequalities in being on track of ECD among children with various levels of SDH.

Results

Almost 69% of children were on track in their ECD, a higher percentage in 2019 (74.85%) than in 2017 (65.37%). The prevalence of children on track in their ECD significantly rises per unit in the score of three SDH composites (adjusted prevalence ratios are 1.04 (95% confidence interval (CI): 1.03–1.04) for summative and standardised indexes and 1.49 (95% CI: 1.41–1.58) for weighted index). There is almost a linear positive relationship between the SDH composite and ECD. Significant concentration indexes suggest SDH-related inequalities in ECD.

Conclusion

Children's early development can be hampered due to unfavourable SDH. Although ECD plays a vital role in creating and maintaining socio-economic and health inequalities through to adulthood, favourable SDH needs to be ensured during childhood.

目的健康的社会决定因素（SDH）在儿童发展中起着至关重要的作用。然而，这些决定因素往往被忽视。本研究探讨了五项 SDH 复合因素对 36-59 个月大儿童的幼儿发展（ECD）的影响。分析样本包括 25 721 名儿童的幼儿发展数据。ECD 是按照联合国国际儿童紧急基金的心理测量方法计算的。制定了三个 SDH 综合指数，以研究它们对幼儿发展的梯度影响。使用具有稳健方差的泊松回归来研究 SDH 指数与 ECD 之间的关系。计算了集中指数，并绘制了一条集中曲线，以衡量不同SDH水平的儿童在幼儿发展方面的不平等。在幼儿发展方面步入正轨的儿童的比例在SDH三项复合指标得分每增加一个单位的情况下都会显著上升（总和指数和标准化指数的调整流行率为1.04（95%置信区间（CI）：1.03-1.04），加权指数为1.49（95%置信区间（CI）：1.41-1.58））。SDH 综合指数与 ECD 之间几乎呈线性正相关。显著的集中指数表明与 SDH 相关的幼儿发展不平等。虽然幼儿发展在造成和维持直至成年的社会经济和健康不平等方面发挥着至关重要的作用，但仍需在儿童时期确保良好的 SDH。

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引用次数: 0

Diagnostic accuracy of Ages and Stages Questionnaire, Third Edition to identify abnormal or delayed gross motor development in high-risk infants 年龄与阶段问卷（第三版）在识别高风险婴儿粗大运动发育异常或延迟方面的诊断准确性

IF 1.6 4区医学 Q2 PEDIATRICS

Journal of paediatrics and child health

Pub Date : 2024-09-12 DOI: 10.1111/jpc.16665

Marcella T Danks, Peter H Gray, Elizabeth M Hurrion

Aim

To investigate the diagnostic accuracy of parent-completed Ages and Stages Questionnaire, Third Edition (ASQ-3) to identify abnormal or delayed gross motor development in infants born less than 1000 g or less than 28 weeks gestation.

Methods

Prospective cohort study of high-risk infants comparing ASQ-3 as the index test with concurrent score on Alberta Infant Motor Scale (AIMS) as the reference standard, at 4-, 8- and 12-month corrected (post-term) age. Reference standard positivity cut-offs were ‘Abnormal motor development’ (AIMS Clinical Range) and ‘Motor delay’ (AIMS score >1 SD below mean, not captured in Clinical Range).

Results

Participating infants (n = 191) had mean gestational age (95% confidence interval (CI)) 26.8 weeks (26.6–27.1) and mean birthweight (95% CI) 870 g (844–896). AIMS rated 51%, 31% and 23% of infants as having ‘Abnormal motor development’ and 12%, 28% and 13% with ‘Motor delay’, at 4, 8 and 12 months, respectively. Diagnostic accuracy of ASQ-3 to identify abnormal motor development was acceptable for older infants only if ‘Monitor’ cut-off was used: sensitivity (95% CI) 33% (23–44), 86% (73–95) and 80% (63–92) and specificity (95% CI) 84% (74–92), 76% (66–84), and 76% (67–83) at 4, 8 and 12 months, respectively. ASQ-3 sensitivity to identify motor delay was low.

Conclusions

ASQ-3 has poor sensitivity to identify abnormal or delayed motor development at 4 months. Using the ‘Monitor’ cut-off improves the diagnostic accuracy of ASQ-3 for identification of older infants with abnormal motor development who are at high risk of motor disability. However, ASQ-3 has poor sensitivity to identify motor delay. Clinical motor assessment of high-risk infants is recommended, particularly in early infancy.

目的研究由家长填写的年龄与阶段问卷第三版（ASQ-3）的诊断准确性，以识别出生时体重不足 1000 克或妊娠不足 28 周的婴儿的粗大运动发育异常或延迟。方法对高风险婴儿进行前瞻性队列研究，在 4 个月、8 个月和 12 个月（足月儿）校正年龄时，将 ASQ-3 作为指标测试，阿尔伯塔婴儿运动量表（AIMS）的同期得分作为参考标准。参考标准的阳性临界值为 "运动发育异常"（AIMS 临床范围）和 "运动发育迟缓"（AIMS 分数低于平均值 1 SD，未纳入临床范围）。结果参与测试的婴儿（n = 191）的平均胎龄（95% 置信区间 (CI)）为 26.8 周（26.6-27.1），平均出生体重（95% CI）为 870 克（844-896）。在 4 个月、8 个月和 12 个月时，AIMS 分别将 51%、31% 和 23% 的婴儿评为 "运动发育异常"，将 12%、28% 和 13% 的婴儿评为 "运动迟缓"。只有在使用 "监测 "临界值的情况下，ASQ-3 对较大婴儿运动发育异常的诊断准确性才可接受：4、8 和 12 个月时的灵敏度（95% CI）分别为 33% (23-44)、86% (73-95) 和 80% (63-92)，特异度（95% CI）分别为 84% (74-92)、76% (66-84) 和 76% (67-83)。结论ASQ-3对识别4个月时运动发育异常或延迟的灵敏度较低。使用 "监测 "分界点可提高 ASQ-3 的诊断准确性，以识别运动发育异常且运动障碍风险较高的大龄婴儿。然而，ASQ-3 在识别运动迟缓方面的灵敏度较低。建议对高风险婴儿进行临床运动评估，尤其是在婴儿早期。

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引用次数: 0