Effects of an Early Intervention Approach for Very Low Birth-Weight Infants

本論文は当院の低出生体重児に対する介入・療育アプローチを提示し, 極低出生体重児を対象としてその効果について検討した。対象は極低出生体重児20例で, 平均出生時体重は1022.8g, 平均在胎週数は28.9週であった。これら対象児をコントロール群と介入実施群の2群に出生時期により分類した。コントロール群(8名)は介入・療育アプローチは行わず, 介入実施群(12名)は在胎週数に換算して修正40週から44週の4週間, 週3回の割合で全12セッション, 1セッション30分程度の介入・療育アプローチを行った。効果判定の指標とレC2群の(1)修正44週時のブラゼルトン新生児行動評価の各クラスター値, (2)修正40週時と44週時のブラゼルトン新生児行動評価の各クラスター値の変化率, 修正12カ月時のベイリー乳幼児発達検査を用いた。その結果, ブラゼルトン新生児行動評価では介入実施群はコントロール群に比べて方位反応, 運動調整, 状態調整, 自律神経系の調整の各クラスター値, 及び補足項目の平均値で有意に改善を示した。また修正12カ月時のベイリー精神運動発達検査の精神発達指数と運動発達指数では2群間で有意差はなかったが, 介入実施群はコントロール群と比較して, それぞれの指数で正常範囲まで達している児の割合が高かった。これらの結果から介入・療育アプローチが新生児行動の安定・組織化を図り, 乳児期の発達を促すものと考えられた。The purpose of this study was to assess the efficacy of our intervention approach designed to promote the neonatal behavioral organization in infants born prematurely. The total sample consisted of 20 very low birth-weight infants, weighing below 1250 g with an average gestational age of 28.9 weeks (SD; 2.4 weeks). The subjects were divided into two groups, an experimental group (n=12) received the Neonatal Bchavioral Assessment Scale (NBAS) based intervention combined with a therapeutic approach for total 12 session during 4 weeks from 40 weeks of postconceptual age, whereas the control group (n-8) received the standard medicalnursing care without the intervention approach. Developmental outcome was assessed both groups assignment using the NBAS examination at 44 weeks of postconceptual age, and the Bayley Scales at 12 months corrected age. The experimental group performed significantly higher scoresad justed on Orientation, Motor performance, State Range, State Regulation, Autonomic Stability cluster and Supplemental Score than the control group. At the results of the Bayley Scales, the experimental group showed no significant difference compared with the control group. However, the majority of experimental group infants were classified within the normal range of development and they showed "earlycatch-up" compared with the control group. These results support the hypothesis that our intervention approach is effective in promoting the neonatal behavioral organization and the developmental outcome for the low birth-weight infants