The Application And Result Analysis Of Postconceptual Age Of 38~58 Weeks Infants On Test Of Infant Motor Performance In Chongqing

ObjectiveWith the improvement of perinatal medical technology,the survival rate of high-risk children with brain injury has been increasing year by year.Preterm infants or newborns with postnatal asphyxia and bronchopulmonary dysplasia have a significantly increased risk of brain injury,motor and cognitive abnormalities.Early detection of infants with high-risk brain injuries and early intervention can significantly improve their prognosis.Early identification and diagnosis are the important basis for identifying early intervention targets and formulating early intervention plans.The neurological assessment method is an important tool for early identification.Because it is economical,practical,and it’s easy to operate,which has been widely promoted and approved.However,at present,there are few assessment tools that can be applied in premature infants and early infants in China.In preterm gestation,Test of Infant Motor Performance(TIMP)and Assessment of General Movements(GMs)are the only widely used tools.TIMP is suitable for infants from 34 weeks to 4 months of postconceptual age,but has not yet been introduced into China.GMs are suitable for babies up to 4 months after birth and have been widely used in China.However,its use has certain limitations.This study intends to apply TIMP to infant assessment and analyze infant TIMP scores in Chongqing.The thesis is aimed to seek reference data for TIMP introduction and application in China by comparing with American norm the TIMP score of 38~58 week infants admitted by 3hospitals in Chongqing Province.Methods1.We conduct assessment tests by TIMP on infants at the postconceptual age of 38~58 weeks admitted by Preterm Follow-Up Clinic and Child Health Care Clinic from January 2016 to December 2016 in Second Affiliated Hospital of Army Medical University,Shapingba District Maternal&Child Health Hospital and Chongqing Health Center for Women&Children.The infants were divided into groups by the postconceptual age,one group of 2 weeks,from 38 weeks to 58 weeks,a total of 10 groups.According to the calculation formula of the cross-sectional sample volume,the number of the sample size for each group is about 60 cases.2.The 5th edition of the TIMP evaluation process was used for evaluation.Prior to the start of the study,the project leader learned the TIMP official website course and passed the verification of preliminary application qualifications.Then through face-to-face training,she passed the official verification check and got the trainer qualification.Afterwards,the doctors who participated in the research project were trained on the 5th edition of the TIMP evaluation process and passed the official course assessment.3.The TIMP contains a total of 42 items.1 to 13 items are observed items.If the corresponding performance is observed,each item is given 1 point,otherwise it is not awarded.Items 14 to 42 are elicited items.The baby will be evaluated for head control,visual and auditory stimuli responses,defensive movements,trunk movements,and limb movements.According to the requirement of the scale,the best reaction was recorded and the score range was 0~6.Some items are scored on the left and right sides respectively.The total score of the scale is 142.To avoid over-fatigue in the baby,try to complete each test within 1test and repeat up to 3 times.If the testing is interrupted,items should be completed in a 2nd session within 24 hours of the 1st.After the evaluation is completed,the observed items and the elicited items score are added together to obtain a total score.Result1.The doctors who participated in this project all passed the official appraisal standards of the American IMPS company.The reliability was passed through the requirement that the mismatch rate was less than 10%.2.A total of 642 cases were collected,including 87 premature infants and 555 full term infants.There were 346 males(53.9%)and 296 females(46.1%).The average sample size was64±6 samples per group,which met the sample size calculation requirements.3.The TIMP scores of local infants increased with the increasing postconceptual age,which increased from 37±5 points in the 38~39~+66 week group to 83±12 points in the 56~57~+66 week group.Based on the obtained local data,the 10th,50th,and 90th percentile curves of the local infants were calculated and plotted.4.According to TIMP 2004 reference standards,the score results are divided into the"average range"(mean±1 SD),"below average"(-1SD to-2SD),"far below average"(less than-2SD),etc.With reference to U.S.standards,this study divides the local reference range.5.The average score for each age group is lower than American norm with statistic difference(P<0.001).The 50th percentile curve for each week in the local infant was lower than the 50th percentile for the American norm in the same age group.The 90th percentile curve for each week group is also lower than the 50th percentile curve for the US norm of the same age group.Conclusion1.Appraisers after standard training can meet the requirement that the score mismatch rate is less than 10%.It shows that TIMP is easy to master and can guarantee high reliability.It is suitable for clinical promotion.2.With the increasing postconceptual age,the TIMP scores from the infants with postconceptual age of 38-58 weeks in three hospitals in Chongqing has also increased,which prompted that TIMP scores can reflect the motor performance in infants with various postconceptual age.3.According to the local data,the local percentile reference curve is drawn and the reference range is determined,which can be used as a preliminary reference for the local infant’s motor ability test.4.According to the scores between America and Chongqing,the TIMP scores from the local infants are significantly lower than that from the American norms.It is suggested that it is very necessary for us to establish the Chinese norms for assessing motor performance in infants before using TIMP.