The predictive value of general movement assessment combined total bilirubin for motor development outcomes in infants with severe neonatal jaundice / 中国医师杂志

ABSTRACT

Objective:To study the predictive values of the general movements (GMs) assessment combined total bilirubin for motor development outcomes in infants with severe neonatal jaundice.Methods:From June of 2014 to June of 2019, infants with severe neonatal jaundice in Chenzhou First People′s Hospital were enrolled in the study. Inclusion criteria included , the serum total bilirubin was measured at the time of admission, corrected gestational age of 37 to 48 weeks. General assessment were carried out when the infant was stable. The patients were regularly followed-up until the age of 12months to evaluate the predictive values.Results:A total of 204 patients with severe neonatal jaundice were enrolled in the study, with mean serum total bilirubin value (485.4±109.6)μmol/L. They were divided into two groups according to the outcome of motor development. The total bilirubin value, the proportion of abnormal GMs and dangerous total bilirubin level in the abnormal group were significantly higher than those in the normal group (all P<0.05). 13 cases (6.4%) were normal in the torsion stage of GMs; 191 cases (93.6%) were abnormal, including 164 cases (85.9%) of poor repertoire (PR) and 27 cases (14.1%) of cramped-synchronized (CS). Abnormal GMs and total bilirubin were the risk factors of abnormal motor development ( OR=4.651, 1.017, P<0.05). The predictive values of abnormal GMs for abnormal motor development outcomes were as following: sensitivity 100%, specificity 8.4%, negative predictive value (NPV) 100%. The predictive values of CS for cerebral palsy were as following: sensitivity 63.2%, specificity 97.8%, NPV 96.0%. Receiver operating characteristic (ROC) curve showed that the area under the curve predicted by GMs and total bilirubin was 0.765 and 0.757, respectively. The area under the curve of motor dysplasia predicted by combining the two was 0.854. Conclusions:The evaluation of general movement assessment combined total bilirubin has certain clinical predictive value for the outcomes of motor development in infants with severe neonatal jaundice.