Moroov refleks kao pokazatelj zrelosti Vestibularnog čula kod novorođenčadi

Abstract

Moroov refleks je obično najranije ispitivani koordinacijski obrazac prilikom procene neurološkog statusa novorođenčeta. Brojne studije još uvek diskutuju poreklo aferentnih puteva za izazivanje Moroovog reflek- sa, bilo da je ono primarno vestibularno, proprioceptivno ili ekstero- ceptivno. Ipak, većina autora zastupa stanovište da je Moroov refleks vestibularni refleks i da nastaje stimulacijom otolita labirinta. Od- sustvo Moroovog refleksa tokom perioda novorođenčeta i ranog odojčeta je bitan dijagnostički znak koji može ukazivati na širok spektar oboljenja centralnog nervnog sistema. Cilj ovog rada je bio da se kroz procenu prisutnosti Moroovog refleksa utvrdi u kojoj meri vestibularno čulo ostvaruje svoju funkciju kod zdrave terminske novorođenčadi. Kliničko ispitivanje Moroovog refleksa (MOR) primenjeno je na uzor- ku od N=100 zdrave, terminske novorođenčadi iz urednih trudnoća, 3. dan po rođenju. Za način ispitivanja MOR-a odabran je najčešće primenjivan, t.zv. „head-drop“ metod koji podrazumeva aktivaciju vestibularisa, oto- lita, a ne taktilnih i proprioceptivnih receptora. Testiranje MOR u ispitivanom uzorku izvodilo je isključivo obučeno medicinsko osoblje, a ispitivač je vršio instruiranje, opservaciju i beleženje podataka. Kod sve novorođenčadi uzeti su podaci o polu, telesnoj težini (TT), telesnoj dužini (TD) i obimu glave (OG). Dobijeni podaci su dokumentovani uz po- moć digitalne kamere, zatim bodovani, statistički i deskriptivno ob- rađeni. Rezultati istraživanja su pokazali da je maksimalna prisutnost MOR utvrđena kod ukupno 52% ispitanog uzorka, dok je bez punog opsega po- kreta ovaj refleks registrovan kod 46% ispitanika. Odsustvo MOR nije zabeleženo ni kod jednog novorođenčeta. Statistički značajna povezanost između pola beba, TT, TD i OG , s jedne strane, i stepena prisutnosti MOR, s druge strane, nije utvrđena.

Moro reflex is commonly the earliest examined coordination pattern when assessing the neurological status of the newborn. Numerous studies are still discussing the origin of afferent pathways for the Moro reflex, whether it is primarily vestibular, proprioceptive, or exteroceptive. Nevertheless, most authors support the viewpoint that Moro reflex is vestibular reflex and that occurs by stimulation of the labyrinth otoliths. The absence of the Moro response during the neonatal period and early infancy is of especial clinical significance and may indicate to a wide range of disorders of the central nervous system. The purpose of this paper was to determine the degree of presence of Moro reflex in the function of evaluating the vestibular sense maturity in healthy term newborns. In a sample of N = 100 healthy, term newborns from normal pregnancies, the 3th day upon birth, clinical trial of Moro reflex (MOR) were applied. For examining of Moro reflex, the so-called head-drop method which involves the activation of vestibularis, otoliths, and not tactile and proprioceptive receptors, has been chosen as the most widely used. Testing of MOR in all babies from the examined sample, was carried out by trained medical staff, whereas the examiner performed instructing, observation and data recording. Besides that, data on body mass on birth, body weight (BW), body length (BL) and head circumference (HC) were recorded for all newborns. The obtained results were recorded by means of a digital camera, then scored and statistically and descriptively processed. Obtained results showed that the maximum presence of MOR was identified in 52% of tested sample, while the reflex without full range of motion, was recorded in 46% of patients. The absence of MOR was not recorded in any of the newborn. Statistically significant connection between babies’ gender, BW, BL and HC, on the one side, and MOR, on the other side, was not established.