早產兒動作里程碑與動作品質之探討

研究背景與目的：隨著醫療進步，妊娠週數較短的早產兒的存活率提高，早產兒面臨較高的動作發展異常風險，因此，早期識別動作發展問題非常關鍵。目前臨床的動作發展評估以動作里程碑的達成為主，但動作里程碑可能無法準確識別低風險早產兒的發展障礙，而動作品質能夠提供不同面向的評估。過去關於動作品質的評估多集中於矯正年齡4個月前，且較少探討不同妊娠週數的早產兒之間的差異。本研究目的為（1）分析早產兒於矯正年齡18個月前的動作里程碑與動作品質發展軌跡與影響因子（2）探討早產兒在早期的動作品質與動作里程碑之關聯（3）比較中晚期早產兒（妊娠週數32-37週）和極早期與早期早產兒（妊娠週數小於32週）的動作品質表現。研究方法：本研究為前瞻性的世代研究，共納入90名早產兒（67名中晚期及23名極早期與早期早產兒），在矯正年齡8個月、12個月、18個月使用嬰幼兒動作評量表（Infant Motor Profile, IMP）進行動作品質評估（包含變異性、適應性、對稱性、流暢度、表現），並同時使用阿爾伯塔嬰兒動作量表（Alberta Infant Motor Scale, AIMS）評估動作里程碑。動作發展的分數與早產兒的產前、新生兒以及家庭因素的相關性以及兩個量表在各年齡間分數之相關性使用Spearman 相關係數檢驗，使用Mann-Whitney檢定比較IMP分數在中晚期早產兒和極早期與早期早產兒之間是否有差異。研究結果：住院天數與矯正年齡8個月時的變異性分數、適應性分數、IMP總分有弱至一般的負相關性。出生體重與矯正年齡8個月時的變異性分數、適應性分數、IMP總分、矯正年齡12個月的流暢度分數、矯正年齡18個月的AIMS總分有弱至一般的相關性。5分鐘阿普伽新生兒評分與矯正年齡8個月的變異性分數、矯正年齡8個月的IMP總分以及矯正年齡18個月的適應性分數有弱的相關性。在矯正年齡8及18個月時的IMP分數（除對稱性以外）皆與AIMS總分呈現顯著正相關（ρ=0.225-0.902，p<0.05），12個月的IMP總分和適應性與AIMS總分呈現顯著負相關（ρ=-0.256，-0.567，p<0.001）。而相較中晚期早產兒，極早期與早期早產兒在8個月時的IMP總分、變異性、適應性，12個月時的AIMS分數，以及18個月時的IMP總分、適應性分數、AIMS分數較低（p<0.05）。結論：早產兒之動作品質與動作里程碑的表現有關，但本研究同時也說明了動作品質能夠反映與動作里程碑不同面向的動作發展。極早期與早期早產兒比起中晚期早產兒在動作品質與動作里程碑表現都較差，而動作品質的差異能夠較早被發現。未來我們可以進一步針對動作品質的預測度進行探討。

Background and Objectives: Recent advances in perinatal and neonatal medicine have increased the survival rates of preterm infants, especially those born at earlier gestational ages. The surviving preterm infants are at a higher risk of motor developmental abnormalities, making the early detection of motor developmental delays imperative. Currently, clinical motor development assessments primarily focus on the achievement of motor milestones. However, milestone-based assessments may not accurately identify developmental disorders in low-risk preterm infants, whereas movement quality provides an alternative and complementary perspective. Previous studies on movement quality have mainly concentrated on assessments before the corrected age of 4 months and have rarely explored differences between preterm infants with varying gestational ages. The objectives of this study are: (1) to analyze the developmental trajectories and influencing factors of motor milestones and movement quality in preterm infants before the corrected age of 18 months; (2) to examine the relationship between movement quality and motor milestones in preterm infants; (3) to compare movement quality between moderate-to-late preterm infants (gestational age 32–37 weeks) and extremely-to-very preterm infants (gestational age <32 weeks). Methods: This prospective cohort study included 90 preterm infants (67 moderate-to-late preterm and 23 extremely-to-very preterm). Motor development assessments were conducted at corrected ages of 8, 12, and 18 months. Movement quality was evaluated using the Infant Motor Profile (IMP), which measures variability, adaptability, symmetry, fluency, and performance. Motor milestones were assessed using the Alberta Infant Motor Scale (AIMS). The relationship between motor development (scores from the IMP and AIMS) and prenatal, neonatal and socioenvironmental factors in preterm infants, as well as the correlations between scores from these two assessment scales at each time point, were analyzed using Spearman's correlation coefficient. The Mann-Whitney U test was used to compare IMP scores between moderate-to-late preterm and extremely-to-very preterm infants.Results: Length of hospitalization was weakly to moderately negatively correlated with variability, adaptability, and total IMP scores at 8 months. Birth weight demonstrated weak to moderate positive correlations with variability, adaptability, and total IMP scores at 8 months, fluency scores at 12 months and AIMS total scores at 18 months. The 5-minute Apgar score showed weak correlations with variability and total IMP scores at 8 months, and adaptability scores at 18 months. At corrected ages of 8 and 18 months, IMP scores (except for symmetry) were significantly positively correlated with AIMS total scores (ρ = 0.225–0.902, all p < 0.05). However, at 12 months, total IMP and adaptability scores were significantly negatively correlated with AIMS total scores (ρ = -0.256 and -0.567, respectively, both p < 0.001). Compared to moderate-to-late preterm infants, extremely-to-very preterm infants had significantly lower scores in total IMP, variation, and adaptability at 8 months, AIMS at 12 months, and total IMP, adaptability, and AIMS at 18 months (all p < 0.05).Conclusions: Movement quality in preterm infants was related to the attainment of motor milestones; however, this study also highlighted that movement quality reflected distinct aspects of motor development not captured by motor milestones. Extremely and very preterm infants showed poorer outcomes in both movement quality and milestones achievement compared to moderate and late preterm infants, with differences in movement quality becoming apparent at an earlier age. Future research could investigate the predictive value of movement quality.