日本未熟児新生児学会雑誌　第17巻　第2号　67～72頁（2005年）

日本未熟児新生児学会雑誌　17(2)：225-230；2005　

受理日：平成16．12．20

アンケート調査に基づくNICUにおける極低出生体重児の神経学的診察の現状について

Neurological Examination of Very Low Birth Weight Infants in Neonatal Intensive Care Units in Japan； A Questionnaire Analysis

東京女子医科大学　乳児行動発達学講座

Department of Infant’s Brain & Cognitive Development, Tokyo Women’s Medical University

中島やよひ・平澤恭子・小西行郎

Yayohi NAKAJIMA，Kyoko HIRASAWA，Yukuo KONISHI

Key Words：neurological examination，VLBW（very low birth weight）infants，NICU（neonatal intensive care unit），brain imaging，prognosis

　NICU内における極低出生体重児の神経学的診察の現状を把握することを目的にハイリスク児フォローアップ研究会の会員医師を対象にアンケート調査を行った。アンケートは364名に郵送し，回答は123名より得られた。診察は修正週数に応じた診察項目を組み合わせて評価されていた。体系化された診察法を採用していたのは27名（22％）であり，Dubowitz法が最多を占めた。入院中の頭部超音波検査の施行率は90％，MRI検査は76.4％，脳波検査は56.1％であった。予後予測にはMRIの結果を有用とする回答が多かった。画像診断が広く普及している一方，診察による評価は体系的に行われておらず，修正満期以前の極低出生体重児の神経学的診察による評価の困難さが窺えた。診断的に画像所見の果たす役割は大きいが，機能評価である診察は早産児の発達的特徴の理解にとって重要と思われた。

　Very low birth weight（VLBW）infants have a higher risk of neurological abnormalities. Today, the availability of modern techniques such as brain ultrasonography（US）, electroencephalography（EEG）and brain magnetic resonance imaging（MRI）could cause neurological examination to fall from favor as a primary diagnostic tool. We performed a questionnaire survey to examine the use of neurological examination in neonatal intensive care units to identify the role of the procedures in VLBW infants’ care.　　　　
　Members of the Follow-up Study Group for High Risk Infants, a nationwide body in Japan, were asked to complete a questionnaire pertaining to their neurological examination of VLBW. The questionnaire was sent to 364 group members and 123 responses were collected. Nintyseven percent indicated that they used postmenstrual age when assessing neurological findings. The number of observations that were considered applicable increased by age and findings that were considered relevant were combined to assess the neurological status of growing infants. Only 22% of the respondents reported routinely performing structured neurological examinations. Cranial US was performed by 90% of the respondents, MRI by 76%, and EEG by 56%. In the event of an abnormal finding during the initial hospital stay, the examination considered most reliable for predicting the prognosis was MRI. Though neuroimaging has become very helpful for detecting brain injury, neurological examination should still remain as a diagnostic tool in evaluating neurological function and behavioral performance. This is important from the viewpoint of predicting prognosis as well as revealing the developmental process of these infants.