| Objective:To study the value of the common assessment of neurodevelopment in predicting the damage in neurological function of infants with hypoxic ischemic encephalopathy and the functions of early intervention in the prevention and treatment of neurological sequelae in HIE infants in order to provide bases for the detection and prevention of early abnormal neurobehavior in high-risk newborns.Methods:1.Objects of study and grouping: HIE group were newborns with middle and serious hypoxic ischemic encephalopathy hospitalized in NICU whose HIE diagnosis was up to the diagnostic criteria. According to the cooperation of their families, 44 infants were divided into the early intervention group, 27 cases were in the non-intervention group, and another 30 normal infants were included in the control group.2. Methods of early intervention: It was carried out by referring to early educational methods for infants of 0 to 3 years old in the book"The Intelligence Development and Education for Children from 0 to 3 Years Old"edited by Chen Daguang and Chen Yanhui. Vojta inducement training and Bobath limb function training were given according to the results of assessment of neurodevelopment. Behavior intervention was carried out in the pattern under the cooperation of the hospital and families. Regular parental guidance was given to both of the two groups.3. Detection of neurodevelopment: NBNA, Vojta posture reflection, Amil-Tison and Gesell assessment law were used. Infants in the early intervention group and the non-intervention group were given NBNA examination 26 to 28 days after their birth, and Vojta posture reflection, Amil-Tison and Gesell assessment law at the age of 2 months, 4 months, 6 months and 9 months. Gesell assessment law was given to infants at the age of 18 months in intervention group, the non-intervention group and the control group. Results:1. General situation: Before birth, there was no statistical difference in children between the early intervention group and non-intervention group in high-risk factors (high-pregnant mother of the merger disease, umbilical cord abnormality, abnormal placenta, multiple pregnancy, etc.), the parents'educational condition and gender(P>0.05); there was no statistical difference between the groups in gestational age, birth weight, Apgar score(5 minutes) and admission time(P>0.05).2. NBNA scores: The NBNA scores in the early intervention group and non-intervention group were lower than 36 26 to 28 days after birth, and there was no obvious difference(P>0.05).3.The comparison of the abnormalities of Vojta posture reflection and Amil-Tison: At the age of 2 months and 4 months, there was no statistical difference in abnormalities through the examination of Vojta and Amil-Tison between the early intervention group and non-intervention group(P>0.05); at the age of 6 months and 9 months, there were differences between the two groups and the abnormalities in non-intervention group were higher(P<0.01).4.The comparison of Gesell evaluation of development between the early intervention group and non-intervention group: at the age of 2 months and 4 months, there was no statistical difference in Gesell scores(DQ) between the two groups(P>0.05); at the age of 6 months and 9 months, the DQ of every ability in the early intervention group was higher than that in non-intervention group(P<0.01).At the age of 18 months, the comparison of DQ between the early intervention group and the normal group showed that there was no statistical difference in adaptability, amount of physical exercise, elaborate activities, language and the social intercourse(P>0.05); the DQ in the early intervention group and the normal group were both obviously higher than that in non-intervention group(P<0.01).The comparison of vertical showed that there was no difference in adaptability, amount of physical exercise, elaborate activities, language and the social intercourse among infants in the early intervention group at the age of 4 months and 2 months, and the differences appeared at the age of 6 months and they continued until the age of 9 months and 18 months(P<0.01), and the DQ of every ability in the early intervention group was higher than before. The comparison of vertical in non-intervention group showed that after 9 months, the DQ in adaptability, amount of physical exercise, elaborate activities, and the social intercourse was higher than before except in language, but the degree was small, while there was no obvious improvement in DQ in language(P>0.05). 5.The comparison of abnormalities among Vojta test, Amil-Tison and GESELL: There was no obvious difference in abnormalities through Vojta test and Amil-Tison at the age of 2 months , 4 months and 6 months(P>0.05); but there were obvious differences compared with Gesell; at the age of 9 months, there was no obvious difference in abnormalities through the three methods(P>0.05).6.The comparison of sequelae of nervous system at the age of 18 months: The incidences of movement deterioration in the early intervention group and non-intervention group were 4.5% and 33.3%, of which the incidence of cerebral palsy were 2.2% and 22.2%; the incidence of language retardation were 4.5% and 37%, of which 2.2% and 29.6% were respectively considered to be mental retardation; there were obvious statistical differences((P<0.001).Conclusion:1. There is still a high incidence of disability in the central nervous system in infants with middle and serious HIE although they have been given early drug treatment. The NBNA scores are lower than 36 26 to 28 days after birth which shows that there is a higher incidence of poor prognosis.2. Early intervention can obviously improve the intelligence development of infants with HIE. The earlier it is used the better the effect is. The effect of early intervention can be greatly improved by using the intervention pattern of the combination of family and the clinic and by giving Vojta induction therapy and Bobath limb function training according to the assessment of neurodevelopment on the basis of intervention of environmental stimulation, behavioral training and cognitive training.3. Vojta posture reflection, Amil-Tison and Gesell are significant in forecasting injury of neurological function in infants with HIE, but there are some differences in the guidance value at different ages. It is safer and convenient to use Vojta posture reflection test to high-risk infants younger than 6 months and it can provide bases for a better targeted intervention. It is better to use Gesell to high-risk infants older than 9 months so as to assess the development of the infants in every aspect, especially to find the related obstacles in cognitive function in order to carry out targeted intervention.
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