低出生体重児を対象としたブラゼルトン新生児行動評価による精神発達遅滞児の判別

ブラゼルトン新生児行動評価法（Neonatal Behavioral Assessment Scale；NBAS）による精神発達遅滞児の鑑別診断の有効性を確認するため，追跡調査の結果を用いた判別分析による検討を行った．対象は新生児期にNBASを行い，3才までの発達経過を確認した低出生体重児86例である．これらの対象児を修正3才時のマッカーシー知能発達検査の結果から，境界値を含む一般知能指数90未満の17例（遅滞群）と，一般知能指数90以上の69例（正常群）の2群に分類し，この2群が胎齢44週時のNBASの結果から既知のグループに正しく区別されるかどうかについて，フィッシャーの線型判別式を用いた判別分析を行った．その結果，胎齢44週時のNBASの結果から正常群では69例中61例（88.5％）が，遅滞群では17例中12例（70.6％）が既知のグループに正しく分類され，その全体に対する割合は84.9％であった．また，一般知能指数と判別結果では指数70～79の遅滞域の4例中1例（25.0％），指数80～89の境界域の9例中4例（44.4％），指数90～120未満の正常域の69例中8例（13.0％）が誤判別であった．次に，関数値と各変数値とのグループ内相関を算出した結果，NBASのクラスターのうち「意識状態の幅」，「運動の調整」，「補足項目値」，「意識状態の調整」，「方位反応」のクラスターが順に統計的に影響力が強く，新生児期の行動評価の必要性を示した．以上より，胎齢44週時のNBASから低体重出生の精神発達遅滞児の判別は高い精度で可能で，早期診断と介入，療育の適応決定に有効であると考えられた．また，より長期的なフォローの必要性も示唆した．The results of a follow-up study were reviewed by discriminant analysis to verify the effectiveness of differential diagnosis for mentally retarded infants by the Brazelton Neonatal Behavioral Assessment Scale (NBAS). The subjects were 86 low birthweight infants for whom the NBAS was performed in the neonatal period and whose developmental progress through age 3 years was confirmed. These infants were divided into 2 groups according to the results of the McCarthy Scales at revised age 3 years, i.e., 17 cases of intelligence quotient (IQ) of less than 90 including borderline area (retarded group) and 69 cases of IS 90 or more (normal group). Fisher\u27s linear discriminant analysis was performed to see if these 2 groups are properly distinguished to the known groups in reference to the results of the NBAS at gestational age 44 weeks. As the result, 61 of the 69 cases in the normal group (88.5%) and 12 of the 17 cases in the retarded group (70.6%) were found to be properly classified in the known groups. The overall rate of proper classification was 84.9%. False discrimination was found in 1 of the 4 cases (25.0%) in the retarded area of IQ 70-79, in 4 of the 9 cases (44.4%) in the borderline area of IQ 80-89, and in 8 of the 69 cases (13.0%) in the normal area of IQ 90-<120. Then, the pooled within-groups correlations between discriminating variables and canonical discriminant functions were calculated. The results showed statistical influences by such NBAS clusters as state range, motor performance, supplemental items, state regulation and orientation, in descending order, indicating the necessity of behavioral assessment in the neonatal period. From the above, it was considered that discrimination of mental retardation in low birthweight infants in reference to the NBAS at gestational age 44 weeks is available at a high accuracy, and that the NBAS is effective on early diagnosis and on determining the application of early intervention and care. It was also indicated that follow-up for a longer period is necessary

ブラゼルトン新生児行動評価の方位反応から見た低出生体重児の新生児行動

LBW児の新生児行動を正常出生児を基準としてみることは母親の不安を増大させる可能性がある．LBW児にはLBW児の新生児行動の特性があると考え，新生児行動評価（NBAS）を用いて検討した．103例のLBW児に対し，のべ316回のNBASを行った．NBASの評価項目の中から方位反応に関する6項目を抽出し，1）評価時期による相違，2）刺激する感覚による相違，3）刺激の質（生命刺激か非生命刺激か）の相違について統計処理を行った．結果として，1）換算45週以降群は各項目の得点が有意に高かった，2）視覚と聴覚の組み合わせによる刺激への反応が高かった，3）視覚および聴覚への単独刺激において生命刺激への反応が高かった．Mothers of low birthweight (LBW) infants often grow anxious as they compair the neonatal behavior of their infants with normal neonatal behavior. In this study, LBW infants were assessed concerning knowledge of a characteristic of neonatal behavior by using Brazelton\u27s Neonatal Behavioral Assessment Scale (NBAS). The assessment was carried out a total of 316 times on 103 LBW infants. Six NBAS orientation items were chosen and were statistically analyzed by 1) difference in age at assessment (measured in terms of gestation), 2) difference in type of sensory stimulation, and 3) difference between inanimate and animate stimulation. Results were that: 1) the group aged at 45 weeks scored significantly higher on every item, 2) combination of visual and auditory stimulation evoked better reaction than other methods, 3) animate stimulation was better than inanimate stimulation in generating infant reaction to both visual and auditory stimulation

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

低出生体重児を対象としたブラゼルトン新生児行動評価による精神発達遅滞児の判別

ブラゼルトン新生児行動評価法（Neonatal Behavioral Assessment Scale；NBAS）による精神発達遅滞児の鑑別診断の有効性を確認するため，追跡調査の結果を用いた判別分析による検討を行った．対象は新生児期にNBASを行い，3才までの発達経過を確認した低出生体重児86例である．これらの対象児を修正3才時のマッカーシー知能発達検査の結果から，境界値を含む一般知能指数90未満の17例（遅滞群）と，一般知能指数90以上の69例（正常群）の2群に分類し，この2群が胎齢44週時のNBASの結果から既知のグループに正しく区別されるかどうかについて，フィッシャーの線型判別式を用いた判別分析を行った．その結果，胎齢44週時のNBASの結果から正常群では69例中61例（88.5％）が，遅滞群では17例中12例（70.6％）が既知のグループに正しく分類され，その全体に対する割合は84.9％であった．また，一般知能指数と判別結果では指数70～79の遅滞域の4例中1例（25.0％），指数80～89の境界域の9例中4例（44.4％），指数90～120未満の正常域の69例中8例（13.0％）が誤判別であった．次に，関数値と各変数値とのグループ内相関を算出した結果，NBASのクラスターのうち「意識状態の幅」，「運動の調整」，「補足項目値」，「意識状態の調整」，「方位反応」のクラスターが順に統計的に影響力が強く，新生児期の行動評価の必要性を示した．以上より，胎齢44週時のNBASから低体重出生の精神発達遅滞児の判別は高い精度で可能で，早期診断と介入，療育の適応決定に有効であると考えられた．また，より長期的なフォローの必要性も示唆した．The results of a follow-up study were reviewed by discriminant analysis to verify the effectiveness of differential diagnosis for mentally retarded infants by the Brazelton Neonatal Behavioral Assessment Scale (NBAS). The subjects were 86 low birthweight infants for whom the NBAS was performed in the neonatal period and whose developmental progress through age 3 years was confirmed. These infants were divided into 2 groups according to the results of the McCarthy Scales at revised age 3 years, i.e., 17 cases of intelligence quotient (IQ) of less than 90 including borderline area (retarded group) and 69 cases of IS 90 or more (normal group). Fisher's linear discriminant analysis was performed to see if these 2 groups are properly distinguished to the known groups in reference to the results of the NBAS at gestational age 44 weeks. As the result, 61 of the 69 cases in the normal group (88.5%) and 12 of the 17 cases in the retarded group (70.6%) were found to be properly classified in the known groups. The overall rate of proper classification was 84.9%. False discrimination was found in 1 of the 4 cases (25.0%) in the retarded area of IQ 70-79, in 4 of the 9 cases (44.4%) in the borderline area of IQ 80-89, and in 8 of the 69 cases (13.0%) in the normal area of IQ 90-<120. Then, the pooled within-groups correlations between discriminating variables and canonical discriminant functions were calculated. The results showed statistical influences by such NBAS clusters as state range, motor performance, supplemental items, state regulation and orientation, in descending order, indicating the necessity of behavioral assessment in the neonatal period. From the above, it was considered that discrimination of mental retardation in low birthweight infants in reference to the NBAS at gestational age 44 weeks is available at a high accuracy, and that the NBAS is effective on early diagnosis and on determining the application of early intervention and care. It was also indicated that follow-up for a longer period is necessary

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