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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Evaluation of the infant at risk for neurodevelopmental disability
C D Molteno1, M C Thompson, S S Buccimazza
1Department of Psychiatry, University of Cape Town.
Insights
Early detection of neurodevelopmental abnormalities in infants is crucial for timely therapy. The Infant Neuromotor Assessment (INA) at 18 weeks shows promise for predicting outcomes in high-risk newborns.
Area of Science:
- Neonatal care and developmental pediatrics.
- Neurological assessment and outcome prediction in infants.
Background:
- Early detection of neurodevelopmental abnormalities in infants is critical for initiating timely interventions.
- Currently, there is a lack of widely accepted methods for early neurodevelopmental evaluation.
Purpose of the Study:
- To compare the predictive accuracy of the perinatal risk rating (PRR), Dubowitz Neurological Assessment (DNA), and Infant Neuromotor Assessment (INA) for 1-year neurodevelopmental outcomes.
- To evaluate the effectiveness of these tools in identifying infants at risk for abnormal neurodevelopment.
Main Methods:
- A prospective follow-up study involving 130 high-risk infants graduating from a neonatal intensive care unit.
- Infants underwent the DNA and PRR at term, the INA at 18 weeks, and a Griffiths Developmental Assessment and neurological examination at 1 year.
Main Results:
- The PRR predicted normal outcome at 1 year with 98% accuracy, while the DNA achieved 96% accuracy.
- The DNA and PRR had lower accuracy in predicting abnormal outcomes (56% and 42%, respectively).
- The INA at 18 weeks demonstrated high predictive value: 99% for normal outcomes (≤3 abnormal signs) and 82% for abnormal outcomes (≥4 abnormal signs).
Conclusions:
- The Infant Neuromotor Assessment (INA) at 18 weeks is a valuable tool for predicting 1-year neurodevelopmental outcomes in high-risk infants.
- A protocol for follow-up of high-risk infants can be developed based on these predictive assessments.
- While PRR and DNA are useful for predicting normal outcomes, INA offers better prediction for abnormal outcomes.
Background:
Infants with neurodevelopmental abnormality need to start therapy early, and because of this they should be detected as soon as possible. Currently, no widely accepted method of early evaluation exists.
Objectives:
To assess and compare, in terms of predicting neurodevelopmental outcome at 1 year of age: (i) a perinatal risk rating (PRR); (ii) the Dubowitz Neurological Assessment (DNA); and (iii) the Infant Neuromotor Assessment (INA).
Design And Setting:
A prospective neurodevelopmental follow-up study on graduates from the Groote Schuur Hospital (GSH) neonatal intensive care unit (NICU).
Subjects:
A cohort of 130 consecutive NICU graduates were selected according to high-risk criteria.
Outcome Measures:
Each infant was examined at term gestational age on the DNA before discharge, and a PRR was allocated. Study infants were seen again at 18 weeks of age when an INA was done, and at 1 year of age a Griffiths Developmental Assessment and full neurological examination was carried out.
Results:
All of the 130 infants assessed at term were seen at 18 weeks. Thereafter 5 were lost to follow-up and 2 died. The outcome for the remaining 123 is known.
Conclusions:
Prediction of a normal outcome at 1 year of age was 96% on the DNA and 98% for the PRR, but for an abnormal outcome they predicted only 56% and 42%, respectively. The INA done at 18 weeks predicted a normal outcome at 1 year in 99% of cases if 3 or less abnormal signs were present and an abnormal outcome in 82% of cases with 4 or more abnormal signs. Based on these findings a protocol for follow-up of these high-risk infants is suggested.
