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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurological assessment at five years of age in infants born preterm
1Department of Neonatal Medicine, Hôpital Jeanne de Flandre, University Hospital, Lille, France.
Insights
A simplified neurological exam for preterm infants showed excellent agreement with Touwen's full exam. This simplified tool can improve follow-up care for preterm neonates.
Area of Science:
- Pediatric Neurology
- Neonatal Follow-up Care
Background:
- Preterm infants require specialized neurological assessments.
- Touwen's neurological examination is a standard but lengthy assessment.
Purpose of the Study:
- To evaluate the agreement between Touwen's neurological examination and a simplified version.
- To assess the utility of a simplified exam for 5-year-old preterm infants.
Main Methods:
- Retrospective review of 170 preterm infants (born <33 wk GA or <1501 g) at a mean age of 5 years 8 months.
- Comparison of Touwen's full neurological examination with a newly derived simplified examination.
- Blinded assessment of concordance between the two examination forms.
Main Results:
- The simplified exam demonstrated excellent agreement with Touwen's full examination (169/170 subjects).
- 28% of the cohort exhibited minor neurological dysfunction (MND).
- No infants with complex MND were misclassified by the simplified exam.
Conclusions:
- A simplified neurological examination is a reliable tool for assessing preterm infants at age 5.
- This simplified approach can enhance the quality of routine follow-up data for preterm neonates.
- The ease of use may facilitate wider adoption in follow-up programs.
Aim:
To evaluate the agreement between Touwen's neurological examination and a derived simplified one, created to be applied at the age of 5 y to infants born preterm.
Methods:
185 children born at a gestational age (GA) of <33 wk and/or with a birthweight <1501 g, free of cerebral palsy, underwent Touwen's neurological examination at a mean age of 5 y and 8 mo (5-6.5 y). One-hundred and seventy had a full examination and were included into the study. They were born at a mean GA of 30 wk (range 24-35 wk) with a mean birthweight of 1250 g (range 600-2690 g). A simplified examination, based on the clinical experience of two of the authors, was created a priori. The data were reviewed retrospectively and the concordance between the two forms was assessed. The reviewers were blinded to the original categorization from the long form.
Results:
On the basis of the original Touwen's neurological examination, the 170 children were classified into 122 with a normal neurological examination, 41 with grade 1 minor neurological dysfunction (MND) and 7 with grade 2 MND, giving 28% of the cohort with MND. The concordance between the two forms was excellent, with an agreement in 169 out of 170 subjects. None of the infants with the most complex form of MND was misclassified.
Conclusion:
The simplicity of this examination could allow its diffusion and its use in follow-up programmes. It could improve the quality of routinely collected follow-up data of preterm neonates.
