UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

新生儿神经系统检查

Author
Suresh Kotagal, MD
Section Editors
Joseph A Garcia-Prats, MD
Douglas R Nordli, Jr, MD
Deputy Editor
Melanie S Kim, MD
Translators
刘登礼, 主任医师，副教授

引言

对于任何疑似有神经系统异常的新生儿都应进行神经系统综合评估，无论这一异常是基于病史(如围生期窒息)推断的还是在新生儿常规评估期间通过体格检查发现的。(参见“新生儿评估”，关于‘神经系统检查’一节)

目前已有一些介绍新生儿神经系统检查的文献[1-15]。基于对上述文献的回顾和作者个人的经验，本专题讨论了新生儿神经系统评估。关于新生儿常规评估的其他方面将单独讨论。(参见“新生儿评估”)

概述

神经系统检查的目的是协助疾病定位、建立诊断，以及在一定程度上预测远期结局[16]。

以下因素可能改变神经系统检查的结果，因此必须将其考虑在内：

  • 婴儿的胎龄(conceptional age, CA)—神经系统检查的正常结果随成熟情况而变。尤其值得指出的是，被动肌张力和姿势随孕龄而变化，Ballard评分用其来评估孕龄(图 1和表 1)。(参见“胎龄的产后评估”，关于‘新Ballard评分’一节和‘被动肌张力/姿势’)
  • 觉醒水平—神经系统检查结果随婴儿觉醒水平而变化。 (参见下文‘觉醒水平’)
  • 医生的经验—许多新生儿神经系统检查依赖于检查者的技术(如，能否引出深腱反射)。
  • 有时需要连续检查以明确神经系统检查结果。

                                     

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2016-05-31.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Amiel-Tison C. Neurological evaluation of the maturity of newborn infants. Arch Dis Child 1968; 43:89.
  2. Brazelton T, Nugent K. Neonatal Behavior Assessment Scale, 3rd ed, Mac Keith Press, London 1995.
  3. Dubowitz LMS, Dubowitz V, Mercuri E. The neurological assessment of the preterm and full-term infant, 2nd ed, Mac Keith Press, London 1999.
  4. Prechtl H. The neurological examination of the full term infant, 2nd ed, London 1977.
  5. Sheridan-Pereira M, Ellison PH, Helgeson V. The construction of a scored neonatal neurological examination for assessment of neurological integrity in full-term neonates. J Dev Behav Pediatr 1991; 12:25.
  6. Als H, Lester B, Tronick E, Brazelton TB. Manual for the assessment of preterm infants' behavior (APIB). In: Theory and Research in Behavioral Pediatrics, Fitzgerald H, Lster B, Yogman M (Eds), Plenum Press, New York p.65.
  7. Morgan AM, Koch V, Lee V, Aldag J. Neonatal neurobehavioral examination. A new instrument for quantitative analysis of neonatal neurological status. Phys Ther 1988; 68:1352.
  8. Campbell, S, Osten, E, Kolobe, T, Fisher, AG. Development of the test of infant motor performance. Physical and Medical Rehabilitation Clinics. 1993; 4:541.
  9. Prechtl H. The neurological examination of the full term newborn infant. Clinics in Developmental Medicine, No. 63, Spastics International Medical Publications, London 1977.
  10. Kroner A, Thom VA. Neurobehavioral assessment of the preterm infant, The Psychological Corporation, New York 1991.
  11. Swaiman KF. Neurological examination of the term and preterm infant. In: Principles and Practice, 4th ed, Swaiman KF, Ashwal S, Ferriero DM (Eds), Mosby Elsevier, Philadelphia 2006. p.47.
  12. Paine RS. Neurological examination of infants and children. Pediatr Clin North Am 1960; 7:41.
  13. Majnemer A, Mazer B. Neurologic evaluation of the newborn infant: definition and psychometric properties. Dev Med Child Neurol 1998; 40:708.
  14. Volpe JJ. The neurological examination: normal and abnormal features. In: Neurology of the newborn, Saunders/Elsevier, Philadelphia 2008. p.121.
  15. Larsen PD, Stensass SS. PediNeurologic Exam. University of Utah School of Medicine, 2005, http://library.med.utah.edu/pedineurologicexam (Accessed on May 27, 2014).
  16. Bax M. Neurological examination of the newborn. Dev Med Child Neurol 1998; 40:651.
  17. Sarnat HB. Olfactory reflexes in the newborn infant. J Pediatr 1978; 92:624.
  18. Shevell M. The tripartite origins of the tonic neck reflex: Gesell, Gerstmann, and Magnus. Neurology 2009; 72:850.
  19. Zafeiriou DI. Primitive reflexes and postural reactions in the neurodevelopmental examination. Pediatr Neurol 2004; 31:1.
  20. Sheppard JJ, Mysak ED. Ontogeny of infantile oral reflexes and emerging chewing. Child Dev 1984; 55:831.
  21. Allen MC, Capute AJ. The evolution of primitive reflexes in extremely premature infants. Pediatr Res 1986; 20:1284.
  22. Capute AJ, Palmer FB, Shapiro BK, et al. Primitive reflex profile: a quantitation of primitive reflexes in infancy. Dev Med Child Neurol 1984; 26:375.
  23. Futagi Y, Suzuki Y, Goto M. Clinical significance of plantar grasp response in infants. Pediatr Neurol 1999; 20:111.
  24. Nelson KB, Ellenberg JH. Neonatal signs as predictors of cerebral palsy. Pediatrics 1979; 64:225.
  25. Allen MC, Capute AJ. Neonatal neurodevelopmental examination as a predictor of neuromotor outcome in premature infants. Pediatrics 1989; 83:498.
  26. Maas YG, Mirmiran M, Hart AA, et al. Predictive value of neonatal neurological tests for developmental outcome of preterm infants. J Pediatr 2000; 137:100.