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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental surveillance in the first 2 years after extremely preterm birth: evidence, challenges, and
1University of Chicago, Pritzker School of Medicine, Kennedy Mental Retardation Center, Comer Children's and LaRabida Children's Hospitals, 5841 S. Maryland Ave., MC0900, Chicago, Illinois 60637, USA. mmsall@peds.bsd.uchicago.edu
Insights
Advances in maternal-fetal medicine improve survival for very preterm infants. New tools assess complex developmental challenges, offering better insights into their neurodevelopmental status and guiding future care.
Area of Science:
- Neonatology
- Maternal-Fetal Medicine
- Developmental Pediatrics
Background:
- Major advances have increased survival rates for very preterm infants.
- These infants face significant respiratory, nutritional, and developmental vulnerabilities.
- Existing assessments of neurodevelopmental outcomes have limitations in capturing complex challenges.
Purpose of the Study:
- To review progress in assessing the early neurodevelopmental status of vulnerable preterm survivors.
- To highlight challenges in current assessment methods.
- To propose evidence-based guidelines for improved assessment.
Main Methods:
- Review of regional trends in neonatal morbidities and neurodevelopmental outcomes.
- Analysis of historical assessment tools focusing on major disabilities.
- Inclusion of recent functional status assessment tools for motor, communication, and social-emotional behaviors.
Main Results:
- Traditional assessments focused on major neurodevelopmental disabilities (e.g., cerebral palsy, blindness).
- These traditional methods may not fully capture resiliency or complex developmental issues.
- Newer tools allow for functional status assessment in gross motor, communication, and social-emotional domains.
Conclusions:
- Current assessment methods for preterm infants are evolving.
- There is a need for comprehensive tools to evaluate a wider range of neurodevelopmental functions.
- Guidelines based on current evidence are proposed to improve early neurodevelopmental assessment for vulnerable survivors.
Abstract:
During the past decade, major advances in maternal-fetal medicine and neonatology have resulted in unprecedented survival of very preterm babies. These babies represent a small fraction of infants born preterm, but present significant challenges with respect to respiratory, nutritional, and developmental vulnerabilities. Several efforts involving the UK, US, Canada, Australia, and the Netherlands have provided information on regional trends over time with respect to neonatal morbidities and neurodevelopmental outcomes through the first two years of life. Historically gross and fine motor, cognitive and communicative skills, vision and hearing performance have been the focus of assessment. Indicators of major neurodevelopmental disabilities at 2 years have included presence of severe neurosensory impairment, i.e. cerebral palsy, sensorineural hearing loss requiring aides, and blindness. In addition cognitive developmental disability has been generally defined as a Bayley MDI or developmental quotient <70, i.e. lower than 2 standard deviations below the mean. However these outcomes cannot reliably capture trajectories of resiliency as well as more complex developmental challenges in the domains of coordination, perception, attention, communication, and learning. Recently tools have become available for assessing functional status in gross motor, communicative, adaptive and social-emotional behaviours of imitation, regulation, and play. This review will describe the major progress in assessing early neurodevelopmental status of vulnerable survivors receiving new biomedical technologies, highlight challenges, and propose guidelines based on current best evidence.
