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1、37北市醫 學雜 誌 第 2 卷 第 8 期， 20 05極低出生體重兒之氣質與發展極低出生體重早產兒之氣質特徵與發展之關係鄒國蘇1、鄒國英3、鄭素芳4、許瓊心5、方麗容21臺北市立聯合醫院婦幼院區早療評估中心、2新生兒科、3輔仁大學醫學系、耕莘醫院小兒科、4國立台灣大學附設醫院復健科、5台北馬偕醫院小兒科受理日期：2004年12月30日；接受日期：2005年7月26日通信作者：鄒國英，輔仁大學醫學系、耕莘醫院小兒科，台北市民生東路五段163 -1號7樓目的：了解大台北地區極低出生體重早產兒之氣質特徵，及其與心理、動作等各項發展間的相關性，並以此作為預防醫療及早期療育之臨床參考。方法：針對84
2、-85年出生於臺大醫院、台北馬偕紀念醫院、台北市立婦幼醫院的極低出生體重早產兒239名及對照組足月正常出生體重兒85名進行前瞻性追蹤，於矯正年齡3歲時施以貝萊嬰幼兒發展測驗、學齡前兒童發展評估及兒童氣質評量。結果：極低出生體重早產兒比對照組活動量較高、較敏感、堅持度較低，且此三項氣質特徵和貝萊嬰幼兒發展測驗心理、動作量表分數及學齡前兒童發展量表中之語言、認知、環境理解、一般性發展均呈顯著負相關。另外，規律性亦和貝萊嬰幼兒發展測驗心理、動作量表分數及語言認知等發展相關達顯著。結論：極低出生體重早產兒之氣質特徵和對照組有顯著不同，且這些相異的氣質特徵和多項發展有顯著相關。故在幼兒期定期作氣質評量，
3、並針對不利於發展之氣質特徵提供適當的諮商指導，是醫療人員對此類發展障礙高危險兒童及其家長相當實際有效的幫助。關鍵詞：極低出生體重早產兒，氣質特徵，發展，發展障礙高危險兒童北市醫學雜誌2005; 2 (8):722-731前言近二 十 年來，在國內由於新生兒加護病房的設立、周產期及新生兒照護醫療水準的進步，使得低出生體重早產兒之存活率明顯增加 1,2。但這些存活下來的早產兒，日後的各項身心發展是否和一般孩子一樣，是值得父母及醫療人員注意的。在國外，已有許多研究顯示極低出生體重早產兒 （ Very Low Birth Weight VLBW ，出生體重1500公克，妊娠週數小於 37週） 日後有認
4、知、語言、動作、學習困難及行為障礙的比例比正常出生體重兒 (Normal Birth Weight, NBW) 高 3, 4, 5。故此類兒童為發展障礙之高危險群 (high riskgroup)。在學齡前兒童，氣質 (temperament) 被認為是影響認知發展的重要因素之一 6。由 Thomas和 Chess 所領導的 New York Longitudinal Study(NYLS)，針對一般兒童及早產兒之行為反應方式及其影響自出生追蹤至成人，他們將個人與生俱來獨特的行為反應方式 (how of behavior) 稱之為氣質，並將其歸納為下列 9 個獨立且具體可量化的行為項目：活動量
5、 (activity level)，規律性(rhythmicity)，注意力分散度 (distractibility)，趨避性 (a p p ro a c h o r wi t hd ra wa l ) ，適應度(adaptability)，堅持度 (persistence and attentionspan)，反應閥 (threshold)， 反應強度 (intensity of46 Taipei City Medical Journal Vol.2 No.8 2005鄒國蘇鄒國英鄭素芳許瓊心方麗容Relationship of Temperamental Characteristics t
6、oDevelopment in Very Low Birth Weight InfantsKuo-Su Tsou, M.D., Kuo-Inn Tsou, M.D.,Suh-Fang Jeng, PT.ScD.Chyong-Hsin Hsu, M.D.,Li-Jung Fang M.D.Key words:very lowbirth weight,temperament, developmentTaipei City Med J 2005; 2 (8):722-7311Taipei Child Development assessment Center, 2Department of Neon
7、atology, Branch for Women and Children, Taipei City Hospital;3College of Medicine,Catholic Fu-Jen University and Department of a Pediatyics,Catholic Tiens Hospital; 4Department of Rehabilitation,National Taiwan University Hospital; 5Department of Pediatrics, Mackay Memorial Hospital, Taipei.Received
8、: 30 December 2004; Accepted: 26 July 2005.Correspondence to: Dr. Kuo-inn Tsou, 7F., No.163-1, Sec. 5, Minsheng E. Rd., Songshan District, Taipei City 105, Taiwan.Background and purpose: This study aimed toinvestigate temperament characteristics and their re-lationship to the mental and motor develo
9、pment of verylow birth weight (VLBW) infants. Methods: A total of239 infants born at the Women and Childrens TaipeiCity Hospital, National Taiwan University Hospital andTaipei MacKay Memorial Hospital during 1985-1986with birth weights under 1,501 gm were recruited pro-spectively as the case group.
10、Eighty three full terminfants, with appropriate birth weights, were recruitedas a control group. The Bayley Scales of Infant Devel-opment (BSID) 2nd ed., Chinese Child DevelopmentInventory (CCDI) and New York Longitudinal Study(NYLS) 3-7 year-old Childrens Temperament Ques-tionnaire were performed a
11、t age three years. Results:Therewere significantdifferences intemperament char-acteristics between the two groups. The VLBW infantshad higher activity levels, lower persistence and lowerthresholds. These three items also correlated signifi-cantly with the Mental Development Index(MDI) scores,Psychom
12、otor Development Index (PDI) scores andCCDI scores in language, cognition, personal-socialand general development, with the exception that ac-tivity had no contribution to the PDI score. Furthermore,rhythmicity also had significant correlation with the MDIand PDI scores, and CCDI scores in language
13、andpersonal-social categories. There were fewer tempera-ment characteristics that correlated significantly withMDI, PDI and CCDI categories in the control group.Conclusions: The temperament characteristics ofVLBW infants correlate significantly with their mentaland motor development. Therefore, early assessmentof development andtemperament among these VLBWinfants, in order to provide proper early intervention, ismandatory to offset adverse outcomes. (Full tex inChinese)
