ブラゼルトン新生児行動評価の臨床活用

我々はこれまでブラゼルトン新生児行動評価法（NBAS）を未熟児やリスクを有する成熟児の早期発達評価と介入手段として応用してきた。今回は未熟児を対象にNBASの評価結果から発達障害を予測された児の新生児行動上の特性を4つの行動系に分けて整理し，我々の実施している早期療育プログラムについて報告した。また，これまでフォローした児について発達経過を加えた。We have applied the Brazelton\u27s Neonatal Behaviour Assessment Scale (NBAS) for the evaluation of early development stages in both premature infants, and mature risk infants, as well as for the clinical application of early intervention method. This paper reports the neonatal behaviour peculiarities of premature infants forecast by NBAS to have mental-motor delays. This paper also report on our practical application of the early intervention program. Finally, we conclude with the progress made in these infant\u27s developments

正常発達を遂げた未熟児または脳性麻痺となった未熟児の新生児行動評価と超早期療育

発達指数では，修正年齢6ヶ月のPDIおよび12ヶ月のMDIにおいて，危険率5％でSFD児がAFD児より低値を示したが，36ヶ月の時点では有意差がなかった．　6ヶ月時の家庭環境値（Caldwell）と発達指数との間に，有意な相関を認めた．　新生児行動評価の個々のクラスター値のみからは発達障害児の予後診断は困難であるが数回の評価を通して，低クラスター値の持続期間とそれらの重複度数とから可能となる．したがって，high risk児に対してはNBASを介入手段として早期評価を実施し，必要に応じて早期療育下に発達経過を観察することが肝要である．In the development of SFD infants, the indices at 6 months and 12 months were significantly lower (P<0.05) compared to AFD infants, whereas the indices at 36 months didn\u27t show significant differences. The environment scores at 6 months by Caldwell (Home) significantly affected the development indices. Prospective diagnosis of high risk infants is difficult when it is based only on the scores of individual clusters for the neonatal behavioral assessment. However, such a prospective diagnosis in the neonatal period is available to some extent when the duration of low cluster scores and the frequency of overlapped lowscores are taken into consideration. It seems essential to perform assessment of high risk infants using the NBAS as a means of early intervention and to observe the process of development under early treatment and care. We would like to carry out further studies with more cases

SFD の新生児行動評価と縦断的発達研究-生後一年間-

長崎大学附属病院小児科未熟児室で集中管理を受けた在胎31週から41週，平均36週，生下時体重1120gから2300g，平均1675gのSFD18例を研究対象とした．　NBAS評価は40，44，48週の計3回施行し，6カ月，12カ月時点での発達評価はBayley乳幼児発達検査を実施し，併せて，生活環境調査もおこなった．さきに調査した成熟児，AFDとも比較検討した．　1．SFDの12カ月時の発達指数はMDI，PDIとも成熟児，AFDと比較して有意に低値を示した．　2．NBAS補足項目中30，33，34，35，36項に反映されるストレス徴候と発達指数との関連性では，ストレス徴候が顕著なほど発達指数は低い傾向にあった．44週時の補足項目では，12カ月時のPDIは5％の危険率でストレス徴候Good群がPoor群より有意に高値を示した．　3．AFD同様，SFD6カ月，1才時のMDI，PDIに，44週時の睡眠‐覚醒リズムの良，不良が深く関与していた．It has constantly been observed that cerebral palsy and/or mental retardation develops among premature and high risk infants. The incidence of mental retardation is particularly high among SFD (small for dates) infants. Assessment using the Neonatal Behavioral Assessment Scale (NBAS) immediately after birth and a longitudinal study on development during the first postnatal year were performed on 18 SFD infants whose development was anticipated to be normal. In comparison with 21 AFD (appropriate for dates) infants and 21 mature infants, the development indices were lower in SFD infants. Two of the 18 SFD infants at corrected age one showed developmental retardation with mental development index (MDI) or psychomotor development index (PDI) less than 70%. The higher were the stressed signs reflected by NBAS supplementary items 30, 33, 34, 35 and 36, the lower were the development indices. As in AFD infants, MDI and PDI were closely associated with the quality of sleep-waking rhythm at 44 weeks

AFDの新生児行動評価と縦断的発達研究-生後一年間-

長崎大学小児科未熟児室で集中管理を受けた在胎28週から35週のAFD16例を研究対象とした。　NBAS評価は36、40、44週の計3回施行し、6カ月、12カ月時点での発達評価はBAYLEY乳幼児発達検査を実施し、併せて、生活環境調査もおこなった。　1、睡眠のリズムと生活環境が1才時点での運動および精神発達指数に大きく影響していた。2、明らかな発達遅滞児2例、脳性麻痺1例を除いた1才時点での発達指数は、運動102.8±7.4、精神105.6±6.1と標準値に達しており、NBASを用いた早期介入がAFDの発達促進に有効であったと推測される。3、発達遅滞児、脳性麻痺児はNBAS補足項目と反射項目で低値を示し、high risk児の評価に有効であった。It has constantly been observe that cerebral palsy and/or mental retardation develops among premature and high risk infants ．Assessment using Neonatal Behavioral Assessment Scale （NBAS）immediately after birth and longitudinal study on development during the first postnatal year were performed on 16 AFD （appropriate for dates ）infants whose normal development was anticipated and 21 mature infants, in order to improve the security of early assessment and early habilitation of handicapped children． NBAS assessment was effective as a means of early intervention ，whereby development Was enhanced in both AFD and mature infants. Of the 13 AFD infants who reached one year of age 1 case was hemiplegic cerebral palsy and 2 cases were motor delay. They showed abnormal values in NBAS supplementary items and reflexes at the neonatal period ．These itmes were Effective for a screening test of high risk infants. The mental development index （MDI） and psychomotor development index （PDI） were closely associate with the quality of sleep-waking ryhthm and the degree of mother\u27s interaction