اراک

‫‪Downloaded from jarums.arums.ac.ir at 11:31 IRST on Friday November 13th 2020‬‬ ‫ﻣﺠﻠـﻪ داﻧﺸﮕـﺎه ﻋﻠـﻮم ﭘــﺰﺷﮑـﯽ اردﺑﯿـﻞ‬

‫دوره ﯾﺎزدﻫﻢ‪ ،‬ﺷﻤﺎره دوم‪ ،‬ﺗﺎﺑﺴﺘﺎن ‪ ،1390‬ﺻﻔﺤﺎت ‪ 143‬اﻟﯽ ‪150‬‬

‫ﺑﺮرﺳﯽ وﺿﻌﯿﺖ ﺗﮑﺎﻣﻞ ﮐﻮدﮐﺎن ‪ 4‬ﺗﺎ ‪ 60‬ﻣﺎﻫﻪ ﺑﺎ ﺳﺎﺑﻘﻪ ﺑﺴﺘﺮي در ﺑﺨﺶ‬
‫ﻣﺮاﻗﺒﺖﻫﺎي وﯾﮋه ﻧﻮزادان ﺑﺮ اﺳﺎس ﭘﺮﺳﺸﻨﺎﻣﻪ ‪ ASQ‬در‬
‫ﺑﯿﻤﺎرﺳﺘﺎن اﻣﯿﺮﮐﺒﯿﺮ اراك‬

‫دﮐﺘﺮ ﻓﺎﻃﻤﻪ دره‪ ،1‬دﮐﺘﺮ ﻏﻼﻣﻌﻠﯽ ﻓﺘﺎﺣﯽ ﺑﯿﺎت‪2‬‬

‫‪1‬ﻧﻮﯾﺴﻨﺪه ﻣﺴﺌﻮل‪ :‬اﺳﺘﺎدﯾﺎر ﮔﺮوه ﮐﻮدﮐﺎن‪ ،‬داﻧﺸﮑﺪه ﭘﺰﺷﮑﯽ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ اراك‪ ،‬اراك‪ ،‬اﯾﺮان ‪E-mail: [email protected]‬‬
‫‪ 2‬اﺳﺘﺎدﯾﺎر ﮔﺮوه ﮐﻮدﮐﺎن‪ ،‬داﻧﺸﮑﺪه ﭘﺰﺷﮑﯽ‪ ،‬داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ اراك‪ ،‬اراك‪ ،‬اﯾﺮان‬

‫ﭼﮑﯿﺪه‬

‫زﻣﯿﻨﻪ و ﻫﺪف‪ :‬ﺑﯿﻤﺎرﯾﺎﺑﯽ و ﺗﺸﺨﯿﺺ زودرس ﺗﺄﺧﯿﺮ ﺗﮑﺎﻣﻠﯽ در ﮐﻮدﮐﺎن ﺧﺼﻮﺻ ًﺎ ﮐﻮدﮐﺎن ﭘﺮﺧﻄﺮ ﺿـﺮوري اﺳـﺖ‪ .‬ﮐﻮدﮐـﺎﻧﯽ ﮐـﻪ‬
‫داراي ﺳﺎﺑﻘﻪ ﯾﮏ ﯾﺎ ﭼﻨﺪ ﻋﺎﻣﻞ ﺧﻄﺮ در دوران ﻗﺒﻞ‪ ،‬ﺣﯿﻦ ﯾﺎ ﭘﺲ از ﺗﻮﻟﺪ ﻫﺴﺘﻨﺪ‪ ،‬ﺷﯿﻮع ﺑﺎﻻﺗﺮ ﺗﺄﺧﯿﺮ ﺗﮑﺎﻣﻞ ﻧﺴﺒﺖ ﺑـﻪ ﺟﻤﻌﯿـﺖ ﻋـﺎدي‬

‫دارﻧﺪ‪ .‬اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺎ ﻫﺪف ﺗﻌﯿﯿﻦ وﺿﻌﯿﺖ ﺗﮑﺎﻣﻞ ﮐﻮدﮐﺎن ﺑﺎ ﺳﺎﺑﻘﻪ ﺑﺴﺘﺮي در ﺑﺨﺶﻫﺎي ﻣﺮاﻗﺒﺖ وﯾﮋه ﻧﻮزادان اﻧﺠﺎم ﺷﺪه اﺳﺖ‪.‬‬
‫روش ﮐﺎر‪ :‬در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ‪ 114‬ﮐﻮدك ﮐﻪ ﺳﺎﺑﻘﻪ ﺑﺴﺘﺮي در ﺑﺨﺶ ﻣﺮاﻗﺒﺖﻫﺎي وﯾـﮋه ﻧـﻮزادان )‪ (NICU‬داﺷـﺘﻪ در ﮔﺮوﻫﻬـﺎي‬
‫ﺳﻨﯽ ‪ 4‬ﺗﺎ ‪ 60‬ﻣﺎﻫﻪ ﺑﺎ ﭘﺮ ﮐﺮدن ﭘﺮﺳﺸﻨﺎﻣﻪ ‪ ASQ‬ﺗﻮﺳﻂ واﻟﺪﯾﻦ آﻧﻬﺎ از ﻧﻈﺮ ﺗﮑﺎﻣﻞ )در ﭘﻨﺞ ﺣﯿﻄﻪ ﺑﺮﻗﺮاري ارﺗﺒﺎط‪ ،‬ﺣﺮﮐﺎت درﺷﺖ‪،‬‬
‫ﺣﺮﮐﺎت ﻇﺮﯾﻒ‪ ،‬ﺷﺨﺼﯽ اﺟﺘﻤﺎﻋﯽ‪ ،‬ﺣﻞ ﻣﺴﺌﻠﻪ( ﺑﺮرﺳﯽ ﺷﺪﻧﺪ‪ .‬اﻃﻼﻋﺎت ﺟﻤﻊآوري ﺷﺪه ﺗﻮﺳـﻂ ﻧـﺮم اﻓـﺰار ‪ SPSS‬ﺑـﺎ اﺳـﺘﻔﺎده از‬

‫ﺷﺎﺧﺺﻫﺎي ﻣﯿﺎﻧﮕﯿﻦ‪ ،‬اﻧﺤﺮاف ﻣﻌﯿﺎر و درﺻﺪ ﻓﺮاواﻧﯽ و آزﻣﻮن ﮐﺎي دو آﻧﺎﻟﯿﺰ ﺷﺪ‪.‬‬
‫ﯾﺎﻓﺘﻪ ﻫﺎ‪ :‬از ‪ 114‬ﻣـﻮرد ‪ %71/1‬ﭘﺴـﺮ و ‪ %70/2‬ﻧـﺎرس ﺑﻮدﻧـﺪ ﺑﯿﺸـﺘﺮﯾﻦ ﻋﻠـﺖ ﺑﺴـﺘﺮي ﻧـﺎرس ﺑـﻮدن و ﻣﯿـﺎﻧﮕﯿﻦ وزن ﻧـﻮزادان‬
‫‪ 2233 ± 680‬ﮔﺮم ﺑﻮده اﺳﺖ‪ .‬در ﺣﯿﻄﻪ ﺑﺮﻗﺮاري ارﺗﺒﺎط ‪ %20/2‬ﺣﺮﮐﺎت درﺷﺖ ‪ %17/5‬ﺣﺮﮐـﺎت ﻇﺮﯾـﻒ ‪ %19/3‬و ﺣـﻞ ﻣﺴـﺌﻠﻪ‬
‫‪ %8/8‬و ﺷﺨﺼﯽ اﺟﺘﻤﺎﻋﯽ ‪ %16/7‬ﻏﯿﺮ ﻃﺒﯿﻌﯽ ﺑﻮدﻧﺪ‪ .‬از ﮐﻮدﮐﺎن ﻣﻮرد ﺑﺮرﺳﯽ ‪ %67/5‬ﻣﻮارد ﺗﮑﺎﻣﻞ ﻃﺒﯿﻌﯽ داﺷـﺘﻪ ‪ %6/1 ،‬در ﮐـﻞ‬
‫ﺣﯿﻄﻪﻫﺎي ﺗﮑﺎﻣﻞ ﻏﯿﺮ ﻃﺒﯿﻌﯽ و ‪ %26/3‬ﺣﺪاﻗﻞ در ﯾﮏ ﺣﯿﻄﻪ ﻏﯿﺮ ﻃﺒﯿﻌﯽ ﺑﻮدﻧﺪ‪ .‬ﺑﯿﻦ ﺣﯿﻄـﻪﻫـﺎي ﻣﺨﺘﻠـﻒ ﺗﮑﺎﻣـﻞ و ﺟـﻨﺲ وﻣـﺪت‬

‫ﺑﺴﺘﺮي ووزن ﻣﻮﻗﻊ ﺗﻮﻟﺪ ارﺗﺒﺎط ﻣﻌﻨﺎدار ﭘﯿﺪا ﻧﺸﺪ‪.‬‬
‫ﻧﺘﯿﺠﻪ ﮔﯿﺮي‪ :‬ﺑﺎ وﺟﻮد ﺗﮑﺎﻣﻞ ﻃﺒﯿﻌﯽ در اﮐﺜﺮ ﮐﻮدﮐﺎن ﺑﺎ ﺳﺎﺑﻘﻪ ﺑﺴﺘﺮي در ‪ ،NICU‬ﺗﻌﺪاد ﻗﺎﺑﻞ ﺗﻮﺟﻬﯽ دﭼﺎر ﺗﺄﺧﯿﺮ ﺗﮑـﺎﻣﻠﯽ‪ ،‬ﺣـﺪاﻗﻞ‬

‫در ﯾﮏ ﺣﯿﻄﻪ ﺑﻮده و ﻧﯿﺎز ﺑﻪ ﺑﺮﻧﺎﻣﻪﻫﺎي ﺑﯿﻤﺎرﯾﺎﺑﯽ و ﭘﯿﮕﯿﺮي ﻣﺪاوم از ﻧﻈﺮ ﺗﮑﺎﻣﻠﯽ ﻣﯽﺑﺎﺷﺪ‪.‬‬
‫ﮐﻠﻤﺎت ﮐﻠﯿﺪي‪ :‬ﺗﮑﺎﻣﻞ؛ ﻧﻮزادان در ﺧﻄﺮ؛ ‪ASQ‬؛ ﺑﺨﺶ ﻣﺮاﻗﺒﺖﻫﺎي وﯾﮋه ﻧﻮزادان‬

‫درﯾﺎﻓﺖ‪ 88/4/7 :‬ﭘﺬﯾﺮش‪90/1/24 :‬‬

‫ﻧﺴﺒﺘﺎً ﻃﺒﯿﻌـﯽ ﺳـﯿﺮ ﻧﺰوﻟـﯽ ﭘﯿـﺪا ﮐـﺮده و ﺑـﻪ ﺗـﺪرﯾﺞ‬ ‫ﻣﻘﺪﻣﻪ‬
‫ﺷﺎﺧﺺﻫﺎي ﺗﮑﺎﻣﻞ ﮐﺴﺐ ﺷﺪه از ﺑﯿﻦ ﺑﺮوﻧﺪ )ﭘﺴﺮﻓﺖ‬ ‫ﺑﻪ ﻃﻮر اﺳﺘﺎﻧﺪارد‪ ،‬ﺷﺎﺧﺺﻫﺎي ﺗﮑﺎﻣﻞ ﺑﺮاي ﻫﺮ ﻣﺎه از‬
‫ﺗﮑﺎﻣﻠﯽ(‪ ،‬ﮔﺎﻫﯽ ﻧﯿﺰ در اﺛﺮ ﺑﺮﺧﯽ وﻗﺎﯾﻊ ﯾﺎ ﺑﯿﻤـﺎريﻫـﺎي‬ ‫رﺷﺪ ﺑﺮاي ﺣﺮﮐﺎت ﻋﻤﺪه و ﻇﺮﯾـﻒ‪ ،‬ارﺗﺒـﺎط و زﺑـﺎن‪،‬‬
‫ﻣﺨﺘﻠﻒ ﻣﻤﮑﻦ اﺳﺖ ﺷﺎﺧﺼﻬﺎي ﮐﺴﺐ ﺷـﺪه ﺑـﻪ ﻃـﻮر‬
‫ﻧﺎﮔﻬﺎﻧﯽ و ﺑﻪ ﺻﻮرت ﻣﻮﻗـﺖ ﯾـﺎ داﺋـﻢ از ﺑـﯿﻦ ﺑﺮوﻧـﺪ‪.‬‬ ‫ﺷﻨﺎﺧﺘﯽ و رﻓﺘﺎري ﺗﻌﺮﯾﻒ ﺷﺪه اﺳﺖ ]‪.[1‬‬
‫ﻋﻮاﻣﻞ ﺧﻄﺮ ﺳﺎز در اﯾﺠﺎد ﺗﺎﺧﯿﺮ ﺗﮑﺎﻣﻞ ﺷﺎﻣﻞ‪ :‬ازدواج‬ ‫ﺷﺎﺧﺺ ﻫﺎي ﺗﮑﺎﻣﻠﯽ ﻣﻤﮑﻦ اﺳﺖ از زﻣﺎن ﺗﻮﻟـﺪ ﺗـﺎﺧﯿﺮ‬
‫داﺷﺘﻪ ﺑﺎﺷﻨﺪ )ﺗﺎﺧﯿﺮ ﺗﮑﺎﻣﻞ(‪ ،‬ﯾﺎ ﭘﺲ از ﯾﮏ دوره ﮐﺎﻣـﻞ‬

‫ﻟﻄﻔﺎ ﺑﻪ اﯾﻦ ﻣﻘﺎﻟﻪ ﺑﻪ ﺷﮑﻞ زﯾﺮ ارﺟﺎع دﻫﯿﺪ‪:‬‬

‫‪Dorre F, Fattahi Bayat GA. Evaluation of children’s development (4-60mo) with history of NICU admission‬‬
‫‪based on ASQ in Amir kabir Hospital, Arak. J Ardabil Univ Med Sci. 2011; 11(2): 143-150. (Full text in‬‬
‫)‪persain‬‬

‫‪Downloaded from jarums.arums.ac.ir at 11:31 IRST on Friday November 13th 2020‬‬ ‫دوره ﯾﺎزدﻫﻢ‪ ،‬ﺷﻤﺎره دوم‪ ،‬ﺗﺎﺑﺴﺘﺎن ‪1390‬‬ ‫‪ 144‬ﻣﺠﻠﻪ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ اردﺑﯿﻞ‬

‫ﻣـﯽرﺳـﺪ‪ .‬ﯾﮑـﯽ از ﻋﻮاﻣـﻞ ﺧﻄـﺮ ﺳـﺎﺑﻘﻪ ﺑﺴـﺘﺮي در‬ ‫ﻓﺎﻣﯿﻠﯽ‪ ،‬ﺳﻦ ﻣـﺎدر در زﻣـﺎن ﺑـﺎرداري‪ ،‬ﭼﻨـﺪ ﻗﻠـﻮﯾﯽ‪،‬‬
‫‪ 2NICU‬اﺳﺖ‪ .‬ﻫﻤﺎﻧﻄﻮر ﮐﻪ ﭘﺎﺳﺦ ﺑﻪ زﻧﺪه ﻣﺎﻧﺪن آﻧﻬﺎ‬ ‫وﺟﻮد ﺑﯿﻤﺎري )ﻣﺜﻞ دﯾﺎﺑﺖ ﻗﻨﺪي‪ ،‬اﻓﺰاﯾﺶ ﻓﺸﺎر ﺧﻮن(‬
‫ﻣﺸﮑﻞ اﺳﺖ ﭘﯿﺶ ﺑﯿﻨﯽ ﺗﮑﺎﻣﻞ آﻧﻬـﺎ ﻧﯿـﺰ ﻣﺸـﮑﻞ اﺳـﺖ‪.‬‬ ‫ﯾﺎ ﻋﻔﻮﻧـﺖ در زﻣـﺎن ﺑـﺎرداري و ﯾـﺎ ﻣﺼـﺮف دارو ﯾـﺎ‬
‫ﺑﺠﺰ ﭼﻨﺪ ﺳﻨﺪرم ارﺛﯽ ﻧﺎﻫﻨﺠﺎري ﻣﻐﺰي ﺧﺎص ﮐﻪ ﭘﯿﺶ‬ ‫ﺗﻮﮐﺴﯿﻦ و ﺗﻤﺎس ﺑﺎ ﺗﺮاﺗﻮژﻧﻬﺎ در دوران ﺑﺎرداري اﺳﺖ‬
‫آﮔﻬﯽ ﻣﺸﺨﺼﯽ دارﻧﺪ ﺳﺎﯾﺮ ﺑﯿﻤﺎرﯾﻬﺎﯾﯽ ﮐﻪ ﻣﻨﺠـﺮ ﺑـﻪ‬ ‫ﻫﻤﭽﻨﯿﻦ وﺟﻮد ﭘﻠﯽ ﻫﯿﺪر آﻣﯿﻨﻮس‪ ،‬زاﯾﻤـﺎن زودرس‪،‬‬
‫ﺑﺴﺘﺮي ﺷﺪن ﮐـﻮدك در‪ NICU‬ﻣـﯽﺷـﻮﻧﺪ ﺗـﺎﺛﯿﺮ ﻧـﺎ‬ ‫آﺳﻔﮑﺴﯽ‪ ،‬ﻧﺤﻮهي زاﯾﻤﺎن‪ ،‬ﻋﻮارض ﺑﻌﺪ از ﺗﻮﻟﺪ ﻣﺎﻧﻨـﺪ‬
‫ﻧﺎرﺳﯽ‪ ،‬ﮐﻢﺧﻮﻧﯽ ﻋﻔﻮﻧﺖ‪ ،‬ﮐﺎﻫﺶ ﻗﻨـﺪ ﺧـﻮن و زردي‬
‫ﻣﺸﺨﺼﯽ ﺑﺮ ﺗﮑﺎﻣﻞ او دارﻧﺪ ]‪.[3‬‬ ‫ﻧــﻮزادي و ﯾــﺎ ﻧﺎﻫﻨﺠــﺎري ﻣــﺎدرزادي ﻣﻐــﺰ ﻣﺜــﻞ‬
‫ﻣﺎ در اﯾﻦ ﺗﺤﻘﯿﻖ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﻫﻤﯿـﺖ ﻣﻮﺿـﻮع ﺑـﺮ آن‬ ‫ﻫﯿﺪروﺳــﻔﺎﻟﯽ‪ ،‬ﻣﯿﮑﺮوﺳــﻔﺎﻟﯽ‪ ،‬ﺧــﻮنرﯾــﺰي ﻣﻐــﺰي‬
‫ﺷﺪﯾﻢ ﺗﺎ از ﻃﺮﯾﻖ ﭘﺮﺳﺸﻨﺎﻣﻪ ي ‪ 3ASQ‬ﮐﻮدﮐﺎن ‪4-60‬‬
‫ﻣﺎﻫﻪ ﺑﺎ ﺳﺎﺑﻘﻪ ﺑﺴﺘﺮي در ﺑﺨﺶ ‪ NICU‬در ﻣﺪت ﭘﻨﺞ‬ ‫ﻣﯽﺑﺎﺷﺪ‪.‬‬
‫ﺳﺎل ﮔﺬﺷﺘﻪ )ﺳﺎل ‪ (81-86‬را ﻣـﻮرد ارزﯾـﺎﺑﯽ ﺗﮑـﺎﻣﻠﯽ‬ ‫ﺳﻪ ﻧﻮع اﺧﺘﻼل ﺗﮑﺎﻣﻠﯽ وﺟﻮد دارد‪ :‬اﺧـﺘﻼل ﺣﺮﮐﺘـﯽ ﯾـﺎ‬
‫ﻓﻠﺞ ﻣﻐﺰي‪ ،‬اﺧﺘﻼﻻت رﻓﺘﺎري‪ ،‬اﺧﺘﻼﻻت ﺷﻨﺎﺧﺘﯽ ]‪ .[1‬اﮔﺮ‬
‫ﻗﺮار دﻫﯿﻢ‪.‬‬ ‫ﺑﺨﻮاﻫﯿﻢ آﻣﺎر ﺷـﯿﻮع اﺧـﺘﻼﻻت ﺗﮑـﺎﻣﻠﯽ را ﺑـﺮ اﺳـﺎس‬
‫ﺗﻌﺪاد ﻧﻔﺮات ﻣﺒﺘﻼء در ﻫﺮ ‪ 1000‬ﻧﻔﺮ اراﺋﻪ ﻧﻤﺎﯾﯿﻢ‪ ،‬ﺑـﻪ‬
‫روش ﮐﺎر‬ ‫ﺻﻮرت ذﯾﻞ اﺳﺖ‪ :‬ﻓﻠﺞ ﻣﻐﺰي ‪ ،2-4‬اﺧﺘﻼل ﺑﯿﻨﺎﯾﯽ ‪،3-6‬‬
‫اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﯾﮏ ﭘﮋوﻫﺶ ﺗﻮﺻﯿﻔﯽ ‪ -‬ﻣﻘﻄﻌﯽ ﻣﯽﺑﺎﺷﺪ و‬ ‫اﺧﺘﻼل ﺷﻨﻮاﯾﯽ ‪ ،8-2‬ﻋﻘﺐ اﻓﺘﺎدﮔﯽ ذﻫﻨﯽ ‪ ،25‬ﻧﺎﺗﻮاﻧﺎﯾﯽ‬
‫ﺟﺎﻣﻌﻪي ﭘﮋوﻫﺶ ‪ 114‬ﮐﻮدك ‪ 4-60‬ﻣﺎﻫﻪ ﺑﺴﺘﺮي در‬ ‫ﯾــﺎدﮔﯿﺮي ‪ ،150 1ADHD ،75‬و ﻣﺸــﮑﻼت رﻓﺘــﺎري‬
‫ﺑﺨﺶ ‪ NICU‬ﺑﯿﻤﺎرﺳﺘﺎن اﻣﯿﺮ ﮐﺒﯿـﺮ ﺑـﻮد‪ .‬اﺑـﺰار ﺟﻤـﻊ‬
‫آوري اﻃﻼﻋﺎت ﭘﺮﺳﺸﻨﺎﻣﻪ ‪ ASQ‬و ﻓﺮم ﺗﮑﻤﯿﻠﯽ ﺑﻮد‪.‬‬ ‫‪.[1] 60-130‬‬
‫ﺑﺮاي ﺑﯿﻤﺎرﯾﺎﺑﯽ ﺗﮑﺎﻣـﻞ از آزﻣﻮﻧﻬـﺎ و ﭘﺮﺳﺸـﻨﺎﻣﻪﻫـﺎي‬ ‫ﻫﻤﺎﻧﻄﻮر ﮐﻪ ﻣﻼﺣﻈﻪ ﻣﯽﺷﻮد ﻣﺠﻤﻮع اﯾـﻦ اﺧـﺘﻼﻻت‪،‬‬
‫ﻣﺨﺘﻠﻔﯽ اﺳﺘﻔﺎده ﻣﯽﺷﻮد ﮐـﻪ ﯾﮑـﯽ از ﻣﻨﺎﺳـﺒﺘﺮﯾﻦ اﻧﻬـﺎ‬ ‫رﻗﻢ ﺑﺴﯿﺎر ﺑﺎﻻﯾﯽ ﺧﻮاﻫﺪ ﺷـﺪ و اﯾـﻦ ﻧﺸـﺎن دﻫﻨـﺪهي‬
‫‪ ASQ‬ﻣﯽﺑﺎﺷﺪ‪ .‬در ﺗﺤﻘﯿﻘـﺎت ﻣﺨﺘﻠـﻒ رواﯾـﯽ )‪،(%91‬‬ ‫اﺣﺘﻤـﺎل اﺑـﺘﻼء ﺗﻌـﺪاد زﯾـﺎدي از ﮐﻮدﮐـﺎن اﯾﺮاﻧـﯽ ﺑـﻪ‬
‫ﺣﺴﺎﺳﯿﺖ )‪ (%90‬و اﺧﺘﺼﺎﺻﯽ ﺑـﻮدن ﺗﺴـﺖ )‪(%91-81‬‬ ‫ﻣﺸﮑﻼت ﻓـﻮق و ﻟـﺰوم ﺷﻨﺎﺳـﺎﯾﯽ و درﻣـﺎن ﻫـﺮ ﭼـﻪ‬
‫ﻣـﻮرد ﺗﺎﯾﯿـﺪ ﻗـﺮار ﮔﺮﻓﺘـﻪ اﺳـﺖ ]‪ .[2 ،4-7‬وﻟـﯽ ﺑـﺎ‬ ‫ﺳـﺮﯾﻌﺘﺮ اﯾـﻦ اﻓـﺮاد ﻣـﯽﺑﺎﺷـﺪ‪ .‬ﻣﻬﻤﺘـﺮﯾﻦ ﺿـﺮورت‬
‫ﺑﺮرﺳﯽﻫﺎي اﻧﺠﺎم ﺷﺪه ﻫﯿﭻ ﮐـﺎر ﺗﺤﻘﯿﻘـﺎﺗﯽ در اﯾـﺮان‬ ‫ارزﯾﺎﺑﯽ ﺗﮑﺎﻣﻞ ﮐﻮدﮐﺎن‪ ،‬ﺗﺸﺨﯿﺺ زودرس و ﺑﻪ ﻫﻨﮕﺎم‬
‫ﻣﺒﻨــﯽ ﺑــﺮ ارزﯾــﺎﺑﯽ ﺣﺴﺎﺳــﯿﺖ و اﺧﺘﺼﺎﺻــﯽ ﺑــﻮدن‬ ‫اﺧﺘﻼﻻت ذﻫﻨﯽ‪ ،‬ﺣﺮﮐﺘﯽ‪ ،‬ﺑﯿﻨﺎﯾﯽ و ﺷﻨﻮاﯾﯽ اﺳﺖ ﮐـﻪ در‬
‫ﺻﻮرت ﻣﺪاﺧﻠﻪ درﻣﺎﻧﯽ ﺑﻪ ﻣﻮﻗﻊ ﻗﺎﺑﻞ درﻣﺎن ﻫﺴـﺘﻨﺪ‬
‫ﭘﺮﺳﺸﻨﺎﻣﻪ ‪ ASQ‬ﯾﺎﻓﺖ ﻧﺸﺪ‪.‬‬ ‫و در ﻏﯿﺮ اﯾﻦ ﺻﻮرت ﻣﯽﺗﻮاﻧﻨـﺪ ﻋـﻮارض و اﺧـﺘﻼﻻت‬
‫اﯾﻦ ﺗﺴﺖ ﺣﺎوي ‪ 19‬ﭘﺮﺳﺸﻨﺎﻣﻪ ﻣـﯽﺑﺎﺷـﺪ ﮐـﻪ ﺗﻮﺳـﻂ‬
‫داﺋﻤﯽ ﺑﺮ ﺟﺎي ﮔﺬارﻧﺪ‪.‬‬
‫واﻟﺪﯾﻦ ﭘﺮ ﻣﯽﺷﻮد‪.‬‬ ‫از آﻧﺠﺎﯾﯽ ﮐﻪ ﻓﻘﻂ ‪ %30‬ﺑﭽﻪﻫﺎي ﺑﺎ ﻣﺸﮑﻼت رﻓﺘﺎري و‬
‫ﻫﺮ ﭘﺮﺳﺸﻨﺎﻣﻪ ﺣﺎوي‪ 30‬ﺳﻮال اﺳـﺖ ﮐـﻪ در ‪ 5‬ﺣﯿﻄـﻪ‬ ‫ﺗﮑـﺎﻣﻠﯽ ﺑﻮﺳـﯿﻠﻪ ﻣـﺮاﻗﺒﯿﻦ ﺑﻬﺪاﺷــﺖ اوﻟﯿـﻪ ﻣﺸـﺨﺺ‬
‫ﺑﺮﻗﺮاري ارﺗﺒـﺎط‪ ،‬ﺣﺮﮐـﺎت درﺷـﺖ‪ ،‬ﺣﺮﮐـﺎت ﻇﺮﯾـﻒ‪،‬‬ ‫ﻣﯽﺷﻮﻧﺪ‪ ،‬اﮐﺎدﻣﯽ ﻃﺐ اﻃﻔﺎل آﻣﺮﯾﮑﺎ ﺑﯿﻤﺎرﯾﺎﺑﯽ ﺗﮑﺎﻣـﻞ‬
‫ﻓﺮدي و اﺟﺘﻤﺎﻋﯽ ﺣﻞ ﻣﺸﮑﻞ ﺗﻘﺴﯿﻢ ﺷـﺪه اﺳـﺖ‪ .‬ﯾـﮏ‬
‫ﺑﺨﺶ ﻋﻤﻮﻣﯽ ﻧﯿﺰ ﺑﺮاي ﮐﺴﺐ ﻧﻈﺮات واﻟﺪﯾﻦ در ﻧﻈﺮ‬ ‫را ﺑﺮاي وﯾﺰﯾﺖ ﮐﻮدﮐﺎن ﺳﺎﻟﻢ ﭘﯿﺸﻨﻬﺎد ﻣﯽﮐﻨﺪ ]‪.[2‬‬
‫اﻣﺎ از آﻧﺠﺎﯾﯽ ﮐﻪ ﺑﯿﻤﺎرﯾﺎﺑﯽ در ﻫﻤـﻪ ﮐﻮدﮐـﺎن ﻣﺸـﮑﻞ‬
‫ﮔﺮﻓﺘﻪ ﺷﺪه اﺳﺖ‪.‬‬ ‫اﺳﺖ‪ ،‬ﺑﯿﻤﺎرﯾﺎﺑﯽ در ﮐﻮدﮐﺎن ﺑﺎ ﺧﻄﺮ ﺑﺎﻻ ﻣﻨﻄﻘﯽ ﺑﻨﻈـﺮ‬

‫‪2!Neonatal Intensive Care Unit‬‬ ‫‪1 Attention – Deficit Hyperactivity Disorder‬‬
‫‪3!Ages and Stages Questionnaires‬‬

‫‪Downloaded from jarums.arums.ac.ir at 11:31 IRST on Friday November 13th 2020‬‬ ‫دره و ﻫﻤﮑﺎران ‪145‬‬ ‫ﺑﺮرﺳﯽ وﺿﻌﯿﺖ ﺗﮑﺎﻣﻞ ﮐﻮدﮐﺎن ‪...‬‬

‫ﺑﯿﺸـﺘﺮﯾﻦ ﻋﻠـﺖ ﺑﺴـﺘﺮي ﺑﯿﻤـﺎران در ‪ NICU‬ﻧـﺎرس‬ ‫ﺑﺎ ﻣﺮاﺟﻌﻪ ﺑﻪ دﻓﺘﺮ ﭘﺬﯾﺮش ‪ NICU‬ﺑﯿﻤﺎرﺳﺘﺎن‪ ،‬اﺳﻢ و‬
‫ﺑﻮدن ‪ 43‬ﻣﻮرد )‪ (%37/7‬و ﺳـﭙﺲ ‪ 32 1RDS‬ﻣـﻮرد‬ ‫ﺷﻤﺎره ﭘﺮوﻧﺪهي ﮐﻮدﮐﺎن ‪ 4-60‬ﻣﺎﻫﻪ ﺑﺴﺘﺮي در اﯾﻦ‬
‫)‪ (%28/1‬و ﺗﺎﮐﯽﭘﻨﻪ ﻣﻮﻗﺖ ﻧـﻮزادي ‪ 16‬ﻣـﻮرد )‪(%14‬‬ ‫ﺑﺨﺶ در ﻃﯽ ﭘـﻨﺞ ﺳـﺎل ﮔﺬﺷـﺘﻪ اﺳـﺘﺨﺮاج و از ﺑـﯿﻦ‬
‫ﺑﻮده اﺳﺖ‪ .‬ﻣﯿﺎﻧﮕﯿﻦ وزن ﺗﻮﻟﺪ ﮐﻮدﮐﺎن ﻣﻮرد ﻣﻄﺎﻟﻌـﻪ‬ ‫اﺳـــﺎﻣﯽ ﺑﺼـــﻮرت ﺗﺼـــﺎدﻓﯽ ﺳـــﺎده ﮐﻮدﮐـــﺎن و‬
‫‪ 2233 ± 680‬ﮔـــﺮم و ﮐﻤﺘـــﺮﯾﻦ وزن ‪ 720‬ﮔـــﺮم و‬ ‫ﺧﺎﻧﻮادهﻫﺎﯾﯽ در ﺟﺎﻣﻌـﻪي آﻣـﺎري ﻗـﺮار ﮔﺮﻓـﺖ ﮐـﻪ‬
‫ﺑﯿﺸﺘﺮﯾﻦ وزن ‪ 3550‬ﮔﺮم ﺑﻮد‪.‬ﻣﯿﺎﻧﮕﯿﻦ ﻣﺪت ﺑﺴـﺘﺮي‬ ‫داراي اﯾﻦ ﺷﺮاﯾﻂ ﺑﻮدﻧـﺪ‪ :‬زﻧـﺪه ﺑـﻮدن ﮐﻮدﮐـﺎن‪ ،‬در‬
‫دﺳﺘﺮس ﺑﻮدن ﺧﺎﻧﻮادهﻫﺎ‪ ،‬ﺑﺎﺳﻮاد ﺑﻮدن اﻋﻀﺎء درﺟﻪ‬
‫‪ 10/9 ± 8‬روز ﺑﻮد‪.‬‬ ‫ﯾﮏ ﺧﺎﻧﻮاده‪ ،‬رﺿﺎﯾﺖ ﺑﺮاي ﻫﻤﮑـﺎري ﻧﻤـﻮدن‪ .‬ﭘـﺲ از‬
‫در ﺣﯿﻄﻪ ﺑﺮﻗﺮاري ارﺗﺒﺎط ‪ 91) %79/8‬ﻣﻮرد( ﻃﺒﯿﻌـﯽ‬ ‫ﺑﺮﻗﺮاري ﺗﻤﺎس ﺗﻠﻔﻨﯽ ﺑﺎ ﺧﺎﻧﻮادهﻫـﺎ در ﺟﻬـﺖ ﮐﺴـﺐ‬
‫و ‪ 23) %20/2‬ﻣــﻮرد( ﻏﯿــﺮ ﻃﺒﯿﻌــﯽ ﺑــﻮده و ﺟﻤــﻊ‬ ‫اﻃﻤﯿﻨﺎن از داﺷﺘﻦ ﺷﺮاﯾﻂ ﻋﻨﻮان ﺷـﺪه‪ ،‬ﭘﺮﺳﺸـﻨﺎﻣﻪ و‬
‫اﻣﺘﯿﺎزﺷﺎن ﮐﻤﺘﺮ از ﻧﻘﺎط ﺑﺮش ﻣﺘﻨﺎﺳﺐ ﺑﺎ ﺳﻨﺸﺎن ﺑﻮد‪.‬‬ ‫ﻓﺮم ﺗﮑﻤﯿﻠﯽ را ﺑﻪ درب ﻣﻨﺰل ﮔﺮوه ﻫﺪف ﺑﺮده ﯾﺎ در‬
‫در ﺣﯿﻄﻪ ﺣﺮﮐﺎت درﺷﺖ ‪ 94) %82/0‬ﻣﻮرد( ﻃﺒﯿﻌﯽ و‬ ‫ﺻﻮرت اﻣﮑﺎن ﺑـﻪ درﻣﺎﻧﮕـﺎه ﻣﺮاﺟﻌـﻪ ﮐـﺮده و ﭘـﺲ از‬
‫اراﺋﻪ ﺗﻮﺿﯿﺤﺎت ﻻزم‪ ،‬ﻓﺮمﻫﺎ و ﭘﺮﺳﺸﻨﺎﻣﻪﻫـﺎي ﺗﮑﻤﯿـﻞ‬
‫‪ 20) %17/5‬ﻣﻮرد( ﻏﯿﺮ ﻃﺒﯿﻌﯽ ﺑﻮدﻧﺪ‪.‬‬ ‫ﺷﺪه را درﯾﺎﻓﺖ و ﺳﭙﺲ اﻃﻼﻋـﺎت ﺑﺪﺳـﺖ آﻣـﺪه ﺑـﺎ‬
‫در ﺣﯿﻄﻪ ﺣﺮﮐﺎت ﻇﺮﯾﻒ ‪ 92) %80/7‬ﻣﻮرد( ﻃﺒﯿﻌﯽ و‬ ‫ﻧـﺮم اﻓـﺰار ‪ SPSS‬آﻧـﺎﻟﯿﺰ ﮔﺮدﯾـﺪ‪ .‬در ﺿـﻤﻦ ﻋﻠـﺖ‬
‫ﺑﺴﺘﺮي ﻧﻮزادان ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺗﺸﺨﯿﺺ ﻧﻬﺎﯾﯽ داده ﺷـﺪه‬
‫‪ 22) %19/3‬ﻣﻮرد( ﻏﯿﺮ ﻃﺒﯿﻌﯽ ﺑﻮدﻧﺪ‪.‬‬
‫در ﺣﯿﻄﻪ ﺣﻞ ﻣﺴـﺌﻠﻪ ‪ 104) %91/2‬ﻣـﻮرد( ﻃﺒﯿﻌـﯽ و‬ ‫در ﭘﺮوﻧﺪة ﺑﯿﻤﺎر ﺑﺪﺳﺖ آﻣﺪ‪.‬‬
‫ﺟﻬﺖ آﻧﺎﻟﯿﺰ اﻃﻼﻋﺎت از ﺷﺎﺧﺺﻫﺎي ﻣﯿﺎﻧﮕﯿﻦ‪ ،‬اﻧﺤـﺮاف‬
‫‪ 10) %8/8‬ﻣﻮرد( ﻏﯿﺮ ﻃﺒﯿﻌﯽ ﺑﻮدﻧﺪ‪.‬‬ ‫ﻣﻌﯿﺎر و درﺻﺪ ﻓﺮاواﻧﯽ وﻧﯿﺰ آﻧـﺎﻟﯿﺰ ﺗﺤﻠﯿﻠـﯽ ﮐـﺎي دو‬
‫در ﺣﯿﻄﻪ ﺷﺨﺼﯽ اﺟﺘﻤﺎﻋﯽ ‪ 95) %83/3‬ﻣﻮرد( ﻃﺒﯿﻌﯽ‬
‫اﺳﺘﻔﺎده ﮐﺮدﯾﻢ‪.‬‬
‫و ‪ 19) %16/7‬ﻣﻮرد( ﻏﯿﺮ ﻃﺒﯿﻌﯽ ﺑﻮدﻧﺪ‪.‬‬
‫در ﮐﻞ ﻧﺤـﻮهي ﺗﮑﺎﻣـﻞ ‪ 77) %67/5‬ﻣـﻮرد( ﻃﺒﯿﻌـﯽ و‬ ‫ﯾﺎﻓﺘﻪ ﻫﺎ‬
‫‪ 7) %6/1‬ﻣﻮرد( ﮐـﻞ ﺣﯿﻄـﻪﻫـﺎي ﺗﮑـﺎﻣﻠﯽ ﻏﯿﺮﻃﺒﯿﻌـﯽ‬ ‫از ‪ 114‬ﺑﯿﻤﺎر ﻣﻮرد ﺑﺮرﺳﯽ ‪ 33‬ﻣﻮرد دﺧﺘﺮ )‪(%28/9‬‬
‫داﺷﺘﻨﺪ و ‪ 30) %26/3‬ﻣﻮرد( ﺣـﺪاﻗﻞ در ﯾـﮏ ﺣﯿﻄـﻪ‬ ‫و ‪ 81‬ﻣﻮرد ﭘﺴﺮ )‪ (%71/1‬ﺑﻮدﻧﺪ‪ .‬ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ اﺳـﺘﻔﺎده‬
‫از ﭘﺮﺳﺸـــﻨﺎﻣﻪ ‪ ASQ‬ﺟﻬـــﺖ ﺑﯿﻤـــﺎر ﯾـــﺎﺑﯽ ﺗﮑﺎﻣـــﻞ‬
‫ﻏﯿﺮ ﻃﺒﯿﻌﯽ ﺑﻮدﻧﺪ‪.‬‬ ‫ﺷﯿﺮﺧﻮاران‪ ،‬ﮐﻮدﮐﺎن ﻣﻮرد ﺑﺮرﺳﯽ ﺑﯿﻦ ﺳﻨﯿﻦ ‪ 4‬ﺗﺎ ‪60‬‬
‫ﺑﯿﻦ ﻧﺤﻮهي ﺗﮑﺎﻣﻞ در ﺣﯿﻄﻪﻫﺎي ﻣﺨﺘﻠـﻒ ﺑـﺎ ﺟـﻨﺲ و‬ ‫ﻣﺎﻫﻪ ﺑﻮدﻧﺪ‪ .‬ﻣﯿـﺎﻧﮕﯿﻦ ﺳـﻦ ﮐﻮدﮐـﺎن ﻣـﻮرد ﺑﺮرﺳـﯽ‬
‫ﻫﻤﭽﻨﯿﻦ در ﮐﻞ ﻧﺤﻮهي ﺗﮑﺎﻣﻞ و ﺟﻨﺲ ارﺗﺒﺎط ﻣﻌﻨﺎدار‬
‫ﭘﯿﺪا ﻧﺸﺪ ﺑﯿﻦ ﻣﺪت ﺑﺴﺘﺮي و وزن ﺗﻮﻟﺪ ﺑﺎ اﻣﺘﯿﺎز ﻫـﺮ‬ ‫‪ 17/2  6/1‬ﻣﺎه ﺑﻮد‪.‬‬
‫ﯾﮏ از ﺣﯿﻄﻪﻫﺎي ﺗﮑﺎﻣﻞ ارﺗﺒﺎط ﻣﻌﻨﺎدار وﺟﻮد ﻧﺪاﺷﺖ‪.‬‬ ‫از ﻧﻈﺮ ﺳﻦ ﺣـﺎﻣﻠﮕﯽ ﻣﻮﻗـﻊ ﺗﻮﻟـﺪ ‪ 80‬ﮐـﻮدك ﻣـﻮرد‬
‫وﺿﻌﯿﺖ ﺗﮑﺎﻣﻞ ﮐﻮدﮐﺎن ﺑـﺮ ﺣﺴـﺐ ﻋﻠـﺖ ﺑﺴـﺘﺮي در‬ ‫ﺑﺮرﺳـﯽ )‪ (%70/2‬ﻧـﺎرس و ‪ 34‬ﻣـﻮرد )‪ (%28/8‬ﺗـﺮم‬
‫ﺑﻮدﻧﺪ‪ .‬ﮐﻤﺘﺮﯾﻦ ﺳﻦ ﺣﺎﻣﻠﮕﯽ ‪ 26‬ﻫﻔﺘﻪ و ﺑﯿﺸﺘﺮﯾﻦ ﺳﻦ‬
‫ﺟﺪول ﯾﮏ آورده ﺷﺪه اﺳﺖ‪.‬‬
‫ﺣﺎﻣﻠﮕﯽ ‪ 39‬ﻫﻔﺘﻪ ﺑﻮد‪.‬‬

‫‪1!RDS: Respiratory Distress Syndrome‬‬

‫دوره ﯾﺎزدﻫﻢ‪ ،‬ﺷﻤﺎره دوم‪ ،‬ﺗﺎﺑﺴﺘﺎن ‪1390‬‬ ‫‪ 146‬ﻣﺠﻠﻪ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ اردﺑﯿﻞ‬

‫در ﻣﻄﺎﻟﻌﻪ روﯾﯿﺰ در اﺳﭙﺎﻧﯿﺎ ﻧﯿﺰ در ﭘﯿﮕﯿـﺮي دو ﺳـﺎﻟﮥ‬ ‫ﺟﺪول ‪ .1‬وﺿﻌﯿﺖ ﺗﮑﺎﻣﻞ ﮐﻮدﮐﺎن ﺑﺎ ﺳﺎﺑﻘﻪ ﺑﺴﺘﺮي در ‪ NICU‬ﺑﺮ ﺣﺴﺐ‬
‫ﻧــﻮزادان ﺑــﺎ ﺳــﺎﺑﻘﮥ ﺑﺴــﺘﺮي در ‪ NICU‬ﺷــﯿﻮع ‪1CP‬‬
‫‪ %6/8‬ﻣﺸﺎﺑﻪ ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿﺮ ﺑﻮد وﻟﯽ ﺑـﻪ ﺗﻔﮑﯿـﮏ وزن‪،‬‬ ‫ﻋﻠﺖ ﺑﺴﺘﺮي‬
‫در وزن ﮐﻤﺘﺮ از ‪ 1500‬ﮔﺮم ﺷـﺎﻧﺲ ‪ CP‬ﺑﯿﺸـﺘﺮ ﺑـﻮد‬
‫ﻏﯿﺮﻃﺒﯿﻌﯽ‬
‫]‪.[9‬‬
‫در ﮐﻞ در ﻣﻄﺎﻟﻌﺎت ﺷـﯿﻮع ﻧـﺎﺗﻮاﻧﯽﻫـﺎي ﻣﺨﺘﻠـﻒ در‬ ‫ﻏﯿﺮ ﻃﺒﯿﻌﯽ در ﺑﺮﺧﯽ‬ ‫ﻃﺒﯿﻌﯽ‬ ‫ﻋﻠﺖ ﺑﺴﺘﺮي‬
‫ﮐﻮدﮐﺎن ﺑﺎ رﯾﺴﮏ ﺑﺎﻻ ﻣﺘﻔﺎوت ﺑﻮده اﺳﺖ ﮐﻪ ﺑﻪ ﻋﻠـﺖ‬
‫ﻣﺘﻐﯿﺮ ﺑﻮدن ﻣﻌﯿﺎرﻫﺎي ﻣﻄﺎﻟﻌﻪ‪ ،‬ﺗﺮﮐﯿﺐ ﺟﻤﻌﯿﺖ ﻣـﻮرد‬ ‫ﺣﯿﻄﻪﻫﺎ‬
‫ﻣﻄﺎﻟﻌﻪ‪ ،‬ﻣـﺪت زﻣـﺎن و ﻣﯿـﺰان ﭘﯿﮕﯿـﺮي و اﺑﺰارﻫـﺎي‬
‫‪Downloaded from jarums.arums.ac.ir at 11:31 IRST on Friday November 13th 2020‬‬ ‫ارزﯾﺎﺑﯽ ﻣﯽﺗﻮاﻧﺪ ﺑﺎﺷـﺪ‪ .‬ﺑـﻪ ﻋﻨـﻮان ﻣﺜـﺎل ﭘﯿﮕﯿـﺮي ﺗـﺎ‬ ‫‪(%18/6) 8 (%2/3) 1 (%79/1)34‬‬ ‫ﻧﺎرﺳﯽ‬
‫ﯾﮑﺴﺎل ﻣﻮارد ﺧﻔﯿﻒ ﻓﻠﺞ ﻣﻐﺰي و ﻋﻘﺐ ﻣﺎﻧﺪﮔﯽ ذﻫﻨﯽ‬
‫را ﻣﻤﮑﻦ اﺳﺖ ﻣﺸﺨﺺ ﻧﮑﻨﺪ وﻟﯽ از ﻃﺮﻓﯽ ﺑﺎ ﭘﯿﮕﯿـﺮي‬ ‫ﺳﻨﺪرم دﯾﺴﺘﺮس ‪(%37/5) 12 (%3/1) 1 (%59/4) 19‬‬
‫ﻃﻮﻻﻧﯽﺗﺮ اﺣﺘﻤﺎل اداﻣﻪ ﭘﯿﮕﯿﺮي ﮐﻤﺘﺮ ﻣﯽﺷﻮد ﮐـﻪ در‬
‫ﻣﻄﺎﻟﻌﻪي ﻣﺎ ﺑﭽﻪﻫﺎ ﺗﺎ ﺳﻦ ‪ 60‬ﻣﺎﻫﮕﯽ ﻫﻢ وارد ﻣﻄﺎﻟﻌﻪ‬ ‫ﺗﻨﻔﺴﯽ‬
‫ﺷﺪهاﻧﺪ‪ .‬اﺧﺘﻼﻻت ﺑﯿﻨﺎﯾﯽ و ﺷﻨﻮاﯾﯽ ﺧﻔﯿﻒ اﮔﺮ ارزﯾـﺎﺑﯽ‬
‫ﻣﺨﺼﻮص ﺑﯿﻨﺎﯾﯽ و ﺷﻨﻮاﯾﯽ اﻧﺠﺎم ﻧﺸﻮد ﺗﺸﺨﯿﺺ داده‬ ‫‪(%42/9) 3 (%42/9) 3 (%14/3) 1‬‬ ‫آﺳﻔﮑﺴﯽ‬
‫ﻧﻤﯽﺷﻮد‪ .‬اﺳﺘﻔﺎده از ﭘﺮﺳﺸﻨﺎﻣﻪ ‪ ASQ‬روش ﻣﺴـﺘﻘﯿﻢ‬
‫و ﺧﯿﻠﯽ دﻗﯿﻘﯽ ﺑﺮاي ارزﯾﺎﺑﯽ ﺷﻨﻮاﯾﯽ و ﺑﯿﻨـﺎﯾﯽ ﻧﯿﺴـﺖ‪.‬‬ ‫ﺗﺎﮐﯽ ﭘﻨﻪ ﻣﻮﻗﺖ ‪(%18/8) 3 (%6/3) 1 (%75) 12‬‬
‫اﺧﺘﻼﻻت رﻓﺘـﺎري‪ ،‬ﺗﻤﺮﮐـﺰ‪ ،‬ﺗـﺄﺧﯿﺮ ﺻـﺤﺒﺖ ﮐـﺮدن ﺑـﺎ‬
‫ﺑﺮرﺳـﯽ ‪ 2-6‬ﺳـﺎل ﻣﺸـﺨﺺ ﻣـﯽﺷـﻮد ﮐـﻪ در اﯾـﻦ‬ ‫ﻧﻮزادي‬
‫ﭘﺮﺳﺸﻨﺎﻣﻪ وﺟﻮد دارد‪ .‬اﺧـﺘﻼﻻت ﺧﻔﯿـﻒ ﯾـﺎدﮔﯿﺮي در‬
‫ﺳﻨﯿﻦ ﻣﺪرﺳﻪ و ﺑﺎﻻﺗﺮ ﺑﯿﺸﺘﺮ ﺧﻮدش را ﻧﺸﺎن ﻣﯽدﻫﺪ‬ ‫‪(%50) 2‬‬ ‫‪(%0) 0‬‬ ‫‪(%50) 2‬‬ ‫ﻋﻔﻮﻧﺖ‬

‫ﮐﻪ در ﺑﯿﻤﺎر ﯾﺎﺑﯽ ﺑﺎ ‪ ASQ‬ﻣﺸﺨﺺ ﻧﻤﯽﮔﺮدد‪.‬‬ ‫‪(%0) 0‬‬ ‫‪(%14/3) 1 (%85/7) 6‬‬ ‫ﭘﻨﻮﻣﻮﻧﯽ‬
‫در ﯾﮏ ﻣﻄﺎﻟﻌﻪ ﻣﺸﺎﺑﻪ از ‪ 206‬ﮐـﻮدك ‪ 7-10‬ﺳـﺎﻟﻪ ﺑـﺎ‬
‫ﺳﻦ ﺣـﺎﻣﻠﮕﯽ ﮐﻤﺘـﺮ از ‪ 33‬ﻫﻔﺘـﻪ ‪ %6‬ﻓﻠـﺞ ﻣﻐـﺰي‪%6 ،‬‬ ‫‪(%100) 1‬‬ ‫‪(%0) 0‬‬ ‫‪(%0) 0‬‬ ‫ﻫﯿﭙﻮﮔﻠﯿﺴﻤﯽ‬
‫ﻋﻘﺐ ﻣﺎﻧﺪﮔﯽ ذﻫﻨـﯽ‪ %4 ،‬ﻣﺸـﮑﻞ ﺷـﻨﻮاﯾﯽ‪ %1 ،‬اﺧـﺘﻼل‬
‫‪(%100) 1‬‬ ‫‪(%0) 0‬‬ ‫‪(%0) 0‬‬ ‫ﻣﻨﻨﮋﯾﺖ‬
‫ﺑﯿﻨﺎﯾﯽ و ‪ %5‬اﺧﺘﻼل ﯾﺎدﮔﯿﺮي داﺷﺘﻨﺪ ]‪.[10‬‬
‫در ﻣﻄﺎﻟﻌﻪ دﯾﮕﺮ ﺑﺎ ﭘﯿﮕﯿﺮي ‪ 242‬ﮐﻮدك ﺗـﺎ ‪ 20‬ﺳـﺎﻟﮕﯽ‬ ‫‪(%0) 0‬‬ ‫‪(%0) 0‬‬ ‫‪(%100) 1‬‬ ‫ﻣﺴﻤﻮﻣﯿﺖ‬
‫ﺑﺎ وزن ﺗﻮﻟﺪ ﮐﻤﺘﺮ از ‪ 1500‬ﮔﺮم ‪ %6‬ﻓﻠـﺞ ﻣﻐـﺰي‪%7 ،‬‬
‫ﻋﻘﺐ ﻣﺎﻧﺪه ذﻫﻨﯽ‪ %1 ،‬اﺧﺘﻼل ﺷﻨﻮاﯾﯽ‪ %2 ،‬ﻧﻘﺺ ﺑﯿﻨﺎﯾﯽ‬ ‫‪(%0) 0‬‬ ‫‪(%0) 0‬‬ ‫ﺧﻮﻧﺮﯾﺰي ﻣﻐﺰي ‪(%100) 2‬‬

‫و ‪ %40‬اﺧﺘﻼل ﯾﺎدﮔﯿﺮي داﺷﺘﻨﺪ ]‪.[10‬‬ ‫‪(%26/3) 30 (%6/1) 7 (%67/5) 77‬‬ ‫ﺟﻤﻊ‬
‫در ﻣﻄﺎﻟﻌﻪ اﻓﺘﺨﺎر ﻧﯿﺰ در ﻣﻘﺎﯾﺴـﻪ ‪ 2190‬ﮐـﻮدك ﮐـﻢ‬
‫وزن و ﻃﺒﯿﻌـﯽ در ﭘـﻨﺞ ﺳـﺎﻟﮕﯽ ﻣﻌﯿﺎرﻫـﺎي ﺗﮑﺎﻣـﻞ در‬ ‫ﺑﺤﺚ‬
‫در اﯾﻦ ﻣﻄﺎﻟﻌﻪ از ‪ 114‬ﮐﻮدك ﻣﻮرد ﻣﻄﺎﻟﻌـﻪ ﺣـﺪود‬
‫ﮐﻮدﮐﺎن ﮐﻢ وزن ﺑﻄﻮر ﻣﻌﻨﺎدار ﭘﺎﺋﯿﻦﺗﺮ ﺑﻮد ]‪.[11‬‬ ‫‪ %6‬دﭼﺎر ﺗﺄﺧﯿﺮ ﺗﮑﺎﻣﻞ در ﻫﻤﻪ ﺣﯿﻄﻪﻫﺎ و ‪ %26‬ﺣﺪاﻗﻞ‬
‫در ﯾﮏ ﺣﯿﻄﻪ ﻏﯿﺮ ﻃﺒﯿﻌﯽ ﺑﻮدهاﻧـﺪ‪ .‬ﮐـﻪ ﻧﺘـﺎﯾﺞ ﻣﺸـﺎﺑﻪ‬
‫‪1!Cerebral Pulsy‬‬
‫ﻣﻄﺎﻟﻌﺎت ﻓﺮﻧﺎﻧﺪز و روﯾﯿﺰ ﻣﯽﺑﺎﺷﺪ ]‪.[9،8‬‬
‫در ﻣﻄﺎﻟﻌــﻪ ﻓﺮﻧﺎﻧــﺪز در ﻣﮑﺰﯾــﮏ در ﺑﺮرﺳــﯽ ‪134‬‬
‫ﮐﻮدك ‪ 2‬ﺳﺎﻟﻪ ﺑﺎ ﺳﺎﺑﻘﻪ ﺑﺴﺘﺮي در ‪ NICU‬ﺑﺎ ﻣﺘﻮﺳـﻂ‬
‫ﺳﻦ ﺣﺎﻣﻠﮕﯽ ‪ 32‬ﻫﻔﺘـﻪ و ﻣﯿـﺎﻧﮕﯿﻦ وزن ‪ 1677‬ﮔـﺮم و‬
‫ﺳﺎﺑﻘﻪ ﺑﺴﺘﺮي ‪ 51‬روز ﮐﻪ ‪ %75‬وﻧﺘﯿﻠﻪ ﺑﻮدﻧـﺪ ﻣﺸـﺎﺑﻪ‬
‫اﯾـﻦ ﻣﻄﺎﻟﻌـﻪ ‪ %66/5‬ﻃﺒﯿﻌـﯽ و ‪ %8/2‬ﻧـﻮاﻗﺺ ﺟـﺪي‬
‫داﺷﺘﻨﺪ‪ .‬ﮐﻪ اﺧﺘﻼل ﺗﮑﺎﻣﻞ ارﺗﺒﺎط ﻣﻌﻨﺎدار ﺑﺎ روزﻫﺎﯾﯽ ﮐﻪ‬
‫ﺗﻨﻔﺲ ﻣﺼﻨﻮﻋﯽ داﺷﺘﻨﺪ و روزﻫﺎي ﺑﺴﺘﺮي در ‪NICU‬‬
‫و ﺳﻦ ﺣﺎﻣﻠﮕﯽ داﺷﺖ ]‪ .[8‬در ﻣﻄﺎﻟﻌﻪ ﻣﺎ ارﺗﺒﺎﻃﯽ ﺑـﯿﻦ‬
‫اﺧﺘﻼل ﺗﮑﺎﻣﻞ و وزن ﺗﻮﻟﺪ و ﻣﺪت ﺑﺴﺘﺮي ﯾﺎﻓﺖ ﻧﺸـﺪ‬
‫ﮐﻪ اﺣﺘﻤﺎﻻً ﺑﻪ ﻋﻠﺖ ﮐﻢ ﺑﻮدن ﻣﯿـﺎﻧﮕﯿﻦ ﺑﺴـﺘﺮي )‪10/9‬‬
‫روز( ﻧﺴﺒﺖ ﺑﻪ ﻣﻄﺎﻟﻌﻪ ﻓﻮق و ﺑﺎﻻ ﺑﻮدن ﻣﯿـﺎﻧﮕﯿﻦ وزن‬
‫ﻧﻮزادان )‪ 2233‬ﮔﺮم( در ﻣﻄﺎﻟﻌﻪ ﻣﺎ اﯾﻦ ارﺗﺒﺎط ﯾﺎﻓـﺖ‬
‫ﻧﺸﺪه اﺳﺖ‪ .‬ﻫﺮ ﭼﻨﺪ ﮐـﻪ ﺑـﯿﻦ ﻣـﺪت ﺑﺴـﺘﺮي و وزن‬
‫ﺗﻮﻟـﺪ ارﺗﺒـﺎط ﻣﻌﻨـﺎدار و ﻣﻌﮑـﻮس ﺑﺪﺳـﺖ آﻣـﺪ ﮐـﻪ‬

‫ﻣﻨﻄﻘﯽ ﻧﯿﺰ ﺑﻪ ﻧﻈﺮ ﻣﯽرﺳﺪ‪.‬‬

‫‪Downloaded from jarums.arums.ac.ir at 11:31 IRST on Friday November 13th 2020‬‬ ‫دره و ﻫﻤﮑﺎران ‪147‬‬ ‫ﺑﺮرﺳﯽ وﺿﻌﯿﺖ ﺗﮑﺎﻣﻞ ﮐﻮدﮐﺎن ‪...‬‬

‫اﯾﻦ ﻧﮑﺘﻪ ﻧﯿﺰ ﻗﺎﺑﻞ ﺗﻮﺟﻪ اﺳﺖ ﮐﻪ ﭘﺮﺳﺸﻨﺎﻣﻪ ‪ ASQ‬ﺑـﻪ‬ ‫از ﻧﻈﺮ ﻧﺤﻮهي ﺗﮑﺎﻣﻞ ﺑﺮ ﺣﺴﺐ ﻋﻠﺖ ﺑﺴﺘﺮي ﺑﺎ ﺗﻮﺟـﻪ‬
‫ﻋﻨﻮان ﺑﯿﻤﺎر ﯾﺎﺑﯽ اﺳﺖ و اﻋﺘﺒﺎر اﻋﺘﻤﺎد ‪ 76-91‬درﺻﺪ‬ ‫ﺑﻪ اﯾﻨﮑﻪ در ﻣﻮرد ﺑﻌﻀﯽ ﻋﻠﻞ ﺑﺴﺘﺮي ﻣﻄﺎﻟﻌـﺎت ﮐﻤـﯽ‬
‫ﻣﯽﺑﺎﺷﺪ اﻣﺎ ﻣﻤﮑﻦ اﺳﺖ ﺗﺎ ﺣﺪود ‪ %13‬ﮐﻮدﮐﺎﻧﯽ را ﮐﻪ‬ ‫ﺻﻮرت ﮔﺮﻓﺘﻪ اﺳﺖ‪ ،‬راﺑﻄـﻪاي ﺑـﯿﻦ ﻋﻠـﺖ ﺑﺴـﺘﺮي و‬
‫ﺗﺄﺧﯿﺮ ﺗﮑﺎﻣﻞ ﯾﺎﻓﺖ ﻧﺸﺪ‪ .‬ﻫﺮ ﭼﻨﺪ ﻣﯿﺰان ﻃﺒﯿﻌﯽ ﺑـﻮدن‬
‫اﺧﺘﻼل ﺗﮑﺎﻣﻞ دارﻧﺪ ﻧﺸﺎن ﻧﺪﻫﺪ ]‪.[3‬‬ ‫ﺗﮑﺎﻣﻞ در ﮔﺮوهﻫﺎي ﮐﻪ ﻓﻘﻂ ﺑﻪ ﻋﻠﺖ ﻧﺎرﺳﯽ‪ ،‬ﺗﺎﮐﯽ ﭘﻨﻪ‬
‫از ﻣﺤﺪودﯾﺖﻫﺎي اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻋﺪم دﺳﺘﺮﺳـﯽ‪ ،‬ﻋـﺪم‬ ‫ﮔﺬراي ﻧﻮزادي ﯾﺎ ﭘﻨﻮﻣـﻮﻧﯽ ﺑﺴـﺘﺮي ﺑﻮدﻧـﺪ ﺑـﯿﺶ از‬
‫ﻫﻤﮑﺎري ﯾﺎ ﺑﯿﺴـﻮاد ﺑـﻮدن واﻟـﺪﯾﻦ ﻫﻤـﮥ ﻧـﻮزادان ﺑـﺎ‬ ‫ﮔﺮوه ﺑﺎ ﺳﻨﺪرم زﺟﺮ ﺗﻨﻔﺴﯽ‪ ،‬ﻋﻔﻮﻧﺖ ﻫﯿﭙﻮﮔﻠﯿﺴـﻤﯽ و‬
‫ﺳــﺎﺑﻘﮥ ﺑﺴـﺘﺮي در ‪ NICU‬ﺑـﻮد ﮐـﻪ اﺳـﺘﻔﺎده ﮐـﺎﻣﻼً‬ ‫آﺳﻔﯿﮑﺴﯽ ﺑﻮده اﺳـﺖ‪ .‬در ﻣﻄﺎﻟﻌـﺎت ﻣﺨﺘﻠـﻒ از ﺑـﯿﻦ‬
‫ﺗﺼــﺎدﻓﯽ از ﻧﻤﻮﻧــﻪﻫــﺎ را ﻣﺤــﺪود ﻣــﯽﮐــﺮد‪ .‬از‬ ‫ﺑﯿﻤﺎران ﺑﺴﺘﺮي در ‪ NICU‬ﻋـﻮاﻣﻠﯽ ﻣﺜـﻞ وزن ﺧﯿﻠـﯽ‬
‫ﻣﺤﺪودﯾﺖﻫﺎي دﯾﮕﺮ اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻋـﺪم وﺟـﻮد ﮔـﺮوه‬ ‫ﮐـﻢ ﺣـﯿﻦ ﺗﻮﻟـﺪ‪ ،‬وزن ﮐـﻢ ﻧﺴـﺒﺖ ﺑـﻪ ﺳـﻦ ﺣـﺎﻣﻠﮕﯽ‪،‬‬
‫ﮐﻨﺘﺮل اﺳﺖ ﮐﻪ در ﻣﻄﺎﻟﻌﻪاي ﻣﺸﺎﺑﻪ اﯾـﻦ ﺗﺤﻘﯿـﻖ ﮐـﻪ‬ ‫دﯾﺴـﭙﻼزي ﺑﺮﻧﮑﻮﭘﻮﻟﻤـﻮﻧﺮ‪ ،‬ﻧﺎﻫﻨﺠﺎرﯾﻬـﺎﯾﯽ در ﺗﺼـﺎوﯾﺮ‬
‫وﺿــﻌﯿﺖ ﺗﮑﺎﻣـﻞ ‪ 681‬ﮐـﻮدك ‪ 4-60‬ﻣﺎﻫـﻪ ﻣﺮاﺟﻌـﻪ‬ ‫اﻋﺼﺎب ﻣﺮﮐـﺰي‪ ،1NEC ،‬ﺗﺸـﻨﺞ ﻃـﻮﻻﻧﯽ ﯾـﺎ ﻋﻔﻮﻧـﺖ‬
‫ﮐﻨﻨﺪه ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎن اﻣﯿﺮﮐﺒﯿﺮ اراك را ﺑﺪون در ﻧﻈـﺮ‬ ‫ﺳﯿﺴﺘﻢ ﻋﺼﺒﯽ ﻣﺮﮐﺰي را ﺟﺰ ﻋﻮاﻣﻞ ﺧﻄﺮ ﺑﺮاي اﺧﺘﻼل‬
‫ﮔﺮﻓﺘﻦ ﺳﺎﺑﻘﻪ ﺑﺮرﺳﯽ ﻧﻤﻮده اﺳﺖ ﻧﺸـﺎن داد ﮐـﻪ در‬
‫ﺣﯿﻄﻪﻫﺎي ﻣﺨﺘﻠﻒ و ﺑﻪ ﺗﻔﮑﯿﮏ ﺳﻦ ﺑﯿﻦ ‪ 2/8‬ﺗـﺎ ‪27/8‬‬ ‫ﺗﮑﺎﻣﻞ داﻧﺴﺘﻪاﻧﺪ ]‪.[12-16‬‬
‫درﺻﺪ از ﮐﻮدﮐﺎن ﻣﻮرد ﺑﺮرﺳﯽ دﭼﺎر اﺧﺘﻼل ﺗﮑـﺎﻣﻠﯽ‬ ‫وﻟﯽ در ﻣﻄﺎﻟﻌﻪ ﺑﻠﯿﮕﺮ در ﺑﺮرﺳـﯽ ﺗﮑﺎﻣـﻞ ﻧـﻮزادان ﺑـﺎ‬
‫ﺑﻮدﻧﺪ ﮐﻪ در ﺣﯿﻄﻪي ﺑﺮﻗﺮاري ارﺗﺒﺎط ﺑﯿﺸﺘﺮﯾﻦ ﺗﺄﺧﯿﺮ‬ ‫ﺳﻨﺪرم آﺳﭙﯿﺮاﺳﯿﻮن ﻣﮑﻮﻧﯿﻮم ﻓﻘﻂ ‪ %38‬ﺗﮑﺎﻣﻞ ﻃﺒﯿﻌﯽ‬
‫را داﺷﺘﻨﺪ و در ﻣﻘﺎﯾﺴﻪي ﺗﮏﺗﮏ ﺣﯿﻄﻪﻫﺎ ﺑﺎ ﻣﻄﺎﻟﻌﻪي‬ ‫داﺷﺘﻨﺪ ﮐﻪ ﻧﺸﺎن دﻫﻨﺪه ﭘﯿﺶآﮔﻬﯽ ﺑـﺪ اﯾـﻦ ﺑﯿﻤـﺎران‬
‫ﺣﺎﺿﺮ درﺻﺪ ﮐﻤﺘﺮي از ﮐﻮدﮐﺎن دﭼﺎر اﺧـﺘﻼل ﺗﮑﺎﻣـﻞ‬ ‫ﻧﺴﺒﺖ ﺑﻪ ﺳﺎﯾﺮ ﺑﯿﻤﺎران ﺑﺴﺘﺮي در ‪ NICU‬اﺳﺖ ]‪.[17‬‬
‫ﺑﻮدﻧﺪ ]‪) .[20‬ﺣﺮﮐﺎت ﻇﺮﯾﻒ ‪ %7/3‬در ﻣﻘﺎﺑﻞ ‪،%19/3‬‬ ‫در ﺣﯿﻄــﻪﻫــﺎي ﻣﺨﺘﻠــﻒ ﺗﮑﺎﻣــﻞ ﻣــﻮرد ﺑﺮرﺳــﯽ در‬
‫ﺣﺮﮐﺎت درﺷﺖ ‪ %7/3‬در ﻣﻘﺎﺑـﻞ ‪ ،%17/5‬ﺣـﻞ ﻣﺴـﺌﻠﻪ‬ ‫ﭘﺮﺳﺸﻨﺎﻣﻪ ‪ ASQ‬ﻧﯿﺰ ﺑﯿﺸﺘﺮﯾﻦ ﻣﯿﺰان ﻏﯿﺮﻃﺒﯿﻌﯽ ﺑﻮدن‬
‫‪ %6‬در ﻣﻘﺎﺑــﻞ ‪ ،%8/8‬ﺷﺨﺼــﯽ‪ -‬اﺟﺘﻤــﺎﻋﯽ ‪ %6/5‬در‬ ‫در ﺣﯿﻄﻪ ﺑﺮﻗﺮاري ارﺗﺒﺎط و ﮐﻤﺘﺮﯾﻦ ﻣﯿﺰان در ﺣﯿﻄﻪ‬
‫ﻣﻘﺎﺑــﻞ ‪ ،%16/7‬ﺑﺮﻗــﺮاري ارﺗﺒــﺎط ‪ %8/5‬در ﻣﻘﺎﺑــﻞ‬ ‫ﺣﻞ ﻣﺴﺌﻠﻪ ﺑﻮده اﺳﺖ‪ .‬در ﺣﺎﻟﯿﮑﻪ در ﻣﻄﺎﻟﻌـﻪ ﮐﺮﯾﻤـﯽ‬
‫در ﺑﺮرﺳﯽ ﮐﻮدﮐﺎن ‪ 5‬ﺳﺎﻟﻪ ﺑﺎ وزن ﺗﻮﻟﺪ ‪1500-2500‬‬
‫‪.(%20/2‬‬ ‫در ﻣﻘﺎﯾﺴــﻪ ﮐﻮدﮐــﺎن ﺑــﺎ وزن ﻃﺒﯿﻌــﯽ ﺑــﺮ اﺳــﺎس‬
‫در ﻣﻄﺎﻟﻌﻪ ﮔﺮوﺳﻤﻦ در ﻧﯿﻮﯾـﻮرك ﻧﯿـﺰ در ﺑﺮرﺳـﯽ‬ ‫ﭘﺮﺳﺸـﻨﺎﻣﻪ ‪ ASQ‬اﺧـﺘﻼل ﺗﮑﺎﻣـﻞ ﺑﯿﺸـﺘﺮي داﺷـﺘﻨﺪ و‬
‫‪ 138‬ﮐﻮدك ﻣﺮاﺟﻌـﻪ ﮐﻨﻨـﺪه ﺑـﻪ اورژاﻧـﺲ ﮐﻮدﮐـﺎن‬ ‫ﺑﯿﺸﺘﺮ در ﺣﯿﻄﻪﻫﺎي ﺣﺮﮐﺎت درﺷﺖ و ﻇﺮﯾـﻒ و ﺣـﻞ‬
‫ﺷﻬﺮي ﺑـﺪون ﺳـﺎﺑﻘﻪي ﺗـﺄﺧﯿﺮ ﺗﮑﺎﻣـﻞ ﺑـﺎ اﺳـﺘﻔﺎده از‬
‫ﭘﺮﺳﺸــﻨﺎﻣﻪ ‪ %26/8 ASQ‬ﮐﻮدﮐــﺎن ﺣــﺪاﻗﻞ در ﯾــﮏ‬ ‫ﻣﺴﺌﻠﻪ ﻣﺸﮑﻞ داﺷﺘﻨﺪ ]‪.[18‬‬
‫ﺣﯿﻄﻪ ﺗﺄﺧﯿﺮ ﺗﮑﺎﻣﻞ داﺷـﺘﻨﺪ ﮐـﻪ ﺑﯿﺸـﺘﺮﯾﻦ درﺻـﺪ در‬ ‫در ﻣﻄﺎﻟﻌﻪ ﺳﺎﺟﺪي در ﺗﻬﺮان‪ ،‬از ‪ 403‬ﮐﻮدك ﭘﺮ ﺧﻄﺮ‬

‫ﺣﯿﻄﮥ ﺑﺮﻗﺮاري ارﺗﺒﺎط ﺑﻮده اﺳﺖ ]‪.[21‬‬ ‫‪ %30‬داراي ﺗﺄﺧﯿﺮ ﺗﮑﺎﻣﻞ ﺣﺮﮐﺘﯽ ﺑﻮدهاﻧﺪ ]‪.[19‬‬
‫در ﮐﻞ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻓﺎﮐﺘﻮرﻫﺎي ﺧﻄﺮ ﻣﺘﻌﺪدي ﮐﻪ ﺑﺮاي‬ ‫در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ‪ %18‬ﮐﻮدﮐﺎن اﺧﺘﻼل ﺣﺮﮐﺘﯽ درﺷﺖ ﯾﺎ‬
‫ﺗﮑﺎﻣــﻞ ﻣﻐــﺰ از ﺟﻤﻠــﻪ ﻫﯿﭙﻮﮐﺴــﯽ‪ ،‬اﯾﺴــﮑﻤﯽ‪ ،‬ﮐﻤﺒــﻮد‬ ‫ﻇﺮﯾﻒ داﺷﺘﻨﺪ ﮐﻪ ﺑﺎ ﺗﻮﺟـﻪ ﺑـﻪ اﯾﻨﮑـﻪ اﺧـﺘﻼل ﺣﺮﮐﺘـﯽ‬
‫ﻫﻮرﻣـﻮنﻫـﺎي رﺷـﺪ‪ ،‬ﺗﯿﺮوﺋﯿـﺪ‪ ،‬ﻓﺎﮐﺘﻮرﻫـﺎي ژﻧﺘﯿـﮏ‪،‬‬ ‫ﺑﯿﺸﺘﺮ در ﺳﻨﯿﻦ ﺑﺎﻻﺗﺮ ﺧﻮد را ﻧﺸﺎن ﻣـﯽدﻫـﺪ و اﮐﺜـﺮ‬
‫رادﯾﮑﺎﻟﻬﺎي آزاد و ﺳﯿﺘﻮﮐﯿﻦﻫﺎي ﻣﺨﺘﻠﻒ‪ ،‬ﻧﺎرس ﺑﻮدن‬ ‫ﮐﻮدﮐﺎن ﻣﻮرد ﻣﻄﺎﻟﻌـﻪ زﯾـﺮ ‪ 2‬ﺳـﺎل ﺑـﻮدهاﻧـﺪ ﻗﺎﺑـﻞ‬
‫ﻣﻐـﺰ‪ ،‬ﻋﻮاﻣـﻞ ﻣﺤﯿﻄـﯽ و ﻣﺤـﺮكﻫــﺎي ﻣﺨﺘﻠــﻒ در‬
‫‪ ،NICU‬ﻣﺼـــﺮف داروﻫـــﺎي ﻣﺨﺘﻠـــﻒ در ‪،NICU‬‬ ‫ﺗﻮﺟﯿﻪ اﺳﺖ‪.‬‬

‫‪1Necrotizing Enterocolitis‬‬

Downloaded from jarums.arums.ac.ir at 11:31 IRST on Friday November 13th 2020 1390 ‫ ﺗﺎﺑﺴﺘﺎن‬،‫ ﺷﻤﺎره دوم‬،‫دوره ﯾﺎزدﻫﻢ‬ ‫ ﻣﺠﻠﻪ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ اردﺑﯿﻞ‬148

‫ﻧﺘﯿﺠﻪﮔﯿﺮي‬ ‫ ﻧﻮزادان‬،‫ وﺟﻮد دارد‬CO2 ‫ و‬O2 ‫ ﺗﻐﯿﯿﺮات‬،‫ﺗﻐﯿﯿﺮات دﻣﺎ‬
‫ﻋﻠﯿﺮﻏﻢ اﯾﻨﮑﻪ اﮐﺜـﺮ ﮐﻮدﮐـﺎﻧﯽ ﮐـﻪ ﺳـﺎﺑﻘﻪ ﺑﺴـﺘﺮي در‬ ‫ در ﻣﻌﺮض ﺑﯿﺸـﺘﺮ اﺧـﺘﻼل‬NICU ‫ﺑﺎ ﺳﺎﺑﻘﻪ ﺑﺴﺘﺮي در‬
‫ را دارﻧﺪ از ﻧﻈﺮ ﺗﮑﺎﻣﻠﯽ ﻃﺒﯿﻌﯽ ﻫﺴﺘﻨﺪ وﻟﯽ ﺑـﺎ‬NICU ‫ﺗﮑﺎﻣﻞ ﻫﺴﺘﻨﺪ ﮐﻪ از ﻃﺮﻓﯽ ﻏﯿﺮ ﻗﺎﺑﻞ ﭘﯿﺶ ﺑﯿﻨﯽ ﻫﺴﺘﻨﺪ‬
‫ ﭘﯿﮕﯿﺮي‬، NICU ‫ﺗﻮﺟﻪ ﺑﻪ ﻓﺎﮐﺘﻮرﻫﺎي ﺧﻄﺮ ﻣﺘﻌﺪد در‬
.‫ﻣﻨﻈﻢ اﯾﻦ ﺑﯿﻤﺎران از ﻧﻈﺮ ﺗﮑﺎﻣﻠﯽ ﺣﺎﺋﺰ اﻫﻤﯿـﺖ اﺳـﺖ‬ .[22]
‫ﭼﻮن ﺗﺸﺨﯿﺺ و ﻣﺪاﺧﻠﻪ زودرس ﭘﯿﺶ آﮔﻬﯽ ﺗﮑـﺎﻣﻠﯽ‬ ‫در ﺣﺎل ﺣﺎﺿﺮ ﻣﻄﺎﻟﻌﺎﺗﯽ در ﺧﺼـﻮص ﺑﻬﺒـﻮد ﻧﺤـﻮهي‬
‫ و ﺧﺼﻮﺻـﺎً ﻧـﺎرس‬NICU ‫ﺗﮑﺎﻣﻞ ﻧﻮزادان ﺑﺴـﺘﺮي در‬
.‫اﯾﻦ ﮐﻮدﮐﺎن را ﺑﻬﺒﻮد ﻣﯽﺑﺨﺸﺪ‬ ‫ﺻـﻮرت ﮔﺮﻓﺘـﻪ و ﺗﻮﺻـﯿﻪﻫـﺎﯾﯽ از ﻗﺒﯿـﻞ اﺳـﺘﻔﺎده از‬
‫ ﻣﺤـﺪودﯾﺖ‬،‫ ﻫﯿﭙـﻮﺗﺮﻣﯽ ﻣﺘﻮﺳـﻂ‬،‫ دوﭘﺎﻣﯿﻦ‬،‫ﻣﺴﮑﻦﻫﺎ‬
‫ﺗﺸﮑﺮ و ﻗﺪرداﻧﯽ‬ ‫ ﻫﯿﭙﺮﮐـﺎرﺑﯽ و‬،‫اﺳـﺘﻔﺎده از دﮔﺰاﻣﺘـﺎزون و ﻣﯿـﺪازوﻻم‬
‫ﺑﺪﯾﻨﻮﺳــﯿﻠﻪ از اﻋﻀــﺎي ﻣﺤﺘــﺮم ﺷــﻮراي ﭘﮋوﻫﺸــﯽ‬ ‫ ﮔـﺰاﻧﺘﯿﻦﻫـﺎ ﺻـﻮرت‬، ‫وﻧﺘﯿﻼﺳـﯿﻮن ﺑـﺎ ﻓﺮﮐـﺎﻧﺲ ﺑـﺎﻻ‬
‫داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ اراك ﮐﻪ اﻣﮑﺎن ﭼﻨﯿﻦ ﻣﻄﺎﻟﻌـﻪاي‬
.[22] ‫ﻣﯽﮔﯿﺮد‬
.‫را ﻓﺮاﻫﻢ ﻧﻤﻮدهاﻧﺪ ﻗﺪرداﻧﯽ ﻣﯽﮔﺮدد‬

References ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬

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1390 ‫ ﺗﺎﺑﺴﺘﺎن‬،‫ ﺷﻤﺎره دوم‬،‫دوره ﯾﺎزدﻫﻢ‬ ‫ ﻣﺠﻠﻪ داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ اردﺑﯿﻞ‬150

Evaluation of children’s development (4-60mo) with history of NICU
admission based on ASQ in Amir kabir Hospital, Arak

Dorre F, MD1; Fattahi Bayat GA, MD2

Downloaded from jarums.arums.ac.ir at 11:31 IRST on Friday November 13th 2020 1 Corresponding Author: Assistant Prof. of Pediatrics Dept. School of Medicine, Arak University of Medical
Sciences, Arak, Iran. E-mail: [email protected]
2 Assistant Prof. of Pediatrics Dept., School of Medicine, Arak University of Medical Sciences, Arak, Iran.

ABSTRACT

Background & objectives: Screening and early diagnosis of delayed development in children
particularly among high risk groups are obligatory. Children with a history of one or more
risk factors in pre-natal, peri-natal and post-natal periods are prone to delayed development in
comparison with normal population. This study was launched to assess the developmental
status in children with a history of NICU admission.
Methods: In this study 114 children, aged between 4-60 months with a history of NICU
admission were recruited. ASQ questionnaires including information in 5 fields:
communication, fine and gross motor status, personal-social and problems solving, were
filled for each one of the cases by their parents. The data were analyzed using descriptive
statistics and Chi square test.
Results: Among 114 cases, there were 71.1% male. Totally 70.2% of cases were
premature. The most prevalent reason for admission was immaturity. The average weight
of infants was 2233±680 gram. Figures of abnormal findings in 5 fields were:
communication 20.2%, gross motor 17.5%, fine motor 19.3%, problem solving 8.8% and
personal-social 16.7%. In this study 67.5% of children showed normal development while
6.1% were abnormal in all 5 fields and 26.3% were abnormal in at least one filed.
Statistically, there weren’t significant differences between various developmental fields
and genus, length of hospital stay and birth weight.
Conclusion: Despite normal developmental status in majority of children with a history of
NICU admission, a considerable number of them had delayed development in at least one
field. These findings suggest a need for patient screening and intense follow up programs.
Key words: Development; High Risk Neonate; NICU; ASQ