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Approaches to neurodevelopmental assessment in congenital diaphragmatic hernia survivors
Catherine Chen1, Sandra Friedman, Samantha Butler
1Department of Surgery, Children's Hospital, Boston, MA 02115, USA. catherine.chen@childrens.harvard.edu
Insights
Congenital diaphragmatic hernia survivors show high rates of motor deficits. Physician evaluations effectively identify these issues, while parent reports may underdetect them, highlighting the need for comprehensive screening.
Area of Science:
- Pediatric Surgery
- Neurodevelopmental Pediatrics
- Motor Function Assessment
Background:
- Infants with congenital diaphragmatic hernia (CDH) often experience complex surgical needs and potential neurodevelopmental challenges.
- Assessing motor functioning in CDH survivors is crucial for early intervention and management.
Purpose of the Study:
- To evaluate the performance of parent-reported motor functioning (Developmental Profile-II) and clinical neurodevelopmental pediatrician (MD) evaluations against the gold standard Bayley motor scale in CDH survivors.
Main Methods:
- Bayley motor scale scores were used as the reference standard.
- Sensitivity and specificity of the Developmental Profile-II and MD examinations were calculated.
- Motor scores were dichotomized into normal or abnormal categories.
Main Results:
- A high prevalence of abnormal motor findings was observed (77% on Bayley).
- MD examinations demonstrated high sensitivity (1.0) but lower specificity (0.33) for detecting motor problems.
- Developmental Profile-II showed high specificity (1.0) but low sensitivity (0.2) for physical abnormalities, indicating parental underreporting.
Conclusions:
- The high incidence of motor abnormalities underscores the necessity for continuous screening and evaluation in CDH survivors.
- While MD examinations are sensitive, discrepancies with Bayley scores for hypotonia warrant further investigation.
- Parental reports, despite underreporting, should be considered, and physician-led motor screenings are recommended for comprehensive assessment.
Background:
Infants with congenital diaphragmatic hernia require complex surgical care and may have neurodevelopmental morbidity. We examined the performance of reports of motor functioning in 25 congenital diaphragmatic hernia survivors using the parent-completed Developmental Profile-II and a clinical evaluation by a neurodevelopmental pediatrician (MD) measured against the Bayley motor scale.
Methods:
Bayley motor scores were dichotomized as normal or abnormal. Sensitivity and specificity were calculated for each test.
Results:
The median age at assessment was 25 months. Bayley motor scores were abnormal in 77% of infants tested (10/13). The MD examinations detected motor problems in 92% (12/13). Sensitivity and specificity of the MD examination were 1.0 and 0.33, respectively. Developmental Profile-II physical scores were abnormal in 15% (2/13); sensitivity and specificity were 0.2 and 1.0, respectively.
Conclusions:
The high rate of abnormal motor findings in this study supports the need for ongoing screening and evaluation. The sensitivity of MD examinations was excellent, but hypotonia findings were not universally corroborated by the Bayley. Although specificity of parent-reported motor findings was high, parents underreported abnormal motor findings. Parental reports of neurodevelopmental problems should be heeded, and physicians should perform screening motor examinations. Bayley assessments may be warranted to determine the functional implications of observed abnormalities.
