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Updated: Jul 5, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Comparison of caretaker report and hands-on neurodevelopmental screening in high-risk infants
Glen P Aylward1, Steven J Verhulst
1Division of Developmental and Behavioral Pediatrics, Southern Illinois University School of Medicine, Springfield, IL 62794-9658, USA. Gaylward@siumed.edu
Insights
Caretaker reports using the neurodevelopmental prescreening questionnaire (NPQ) are valuable for high-risk infants. Agreement with the Bayley Infant Neurodevelopmental Screener (BINS) varies by infant risk status and age.
Area of Science:
- Developmental Pediatrics
- Neonatology
- Clinical Assessment
Background:
- Developmental screening of high-risk infants is crucial but caretaker reporting has been understudied.
- Validating caretaker-completed tools against clinical screeners is essential for early identification.
Purpose of the Study:
- To compare caretaker-completed neurodevelopmental prescreening questionnaire (NPQ) with the Bayley Infant Neurodevelopmental Screener (BINS).
- To identify factors influencing agreement between NPQ and BINS in high-risk infants.
Main Methods:
- Prospective evaluation of 471 infants at 6 months, 376 at 12 months, and 244 at 24 months corrected age.
- Caretakers completed the NPQ after watching a video of infants performing items, followed by BINS administration.
- Analysis of sensitivity, specificity, and agreement, examining influence of risk status and background variables.
Main Results:
- Sensitivity ranged from 80%-91%, specificity 57%-82%, and overall agreement 70%-83% across ages.
- Agreement was highest in the high-risk group and lowest in the moderate-risk group.
- Infant neurodevelopmental status was the primary influence at 6-12 months; race and biomedical factors (IVH, RDS) became significant at 24 months.
Conclusions:
- Caretaker-reported NPQ is a useful tool for developmental screening in high-risk infant populations.
- Agreement is influenced by infant neurodevelopmental status, risk stratification, and increasingly by background factors at 24 months.
Abstract:
Caretaker report in developmental screening of high-risk infants has not been investigated adequately. We compare a caretaker-completed neurodevelopmental prescreening questionnaire (NPQ) to a hands-on screener (Bayley Infant Neurodevelopmental Screener; BINS) and attempt to identify factors that influence agreement in a high-risk sample. From 1,436 infants drawn from 5 centers, 471 were prospectively evaluated at 6-months corrected age, 376 at 12-months, and 244 at 24-months. Fifty-five percent were male; 28% African American, 70% Caucasian, 3% other; M gestational age = 31.2 weeks, M birth weight = 1568 g. Caretakers completed the NPQ (based on the BINS) while watching a video depicting infants engaged in items. The BINS was subsequently administered. Sensitivity ranged from 80%-91%, specificity 57%-82%, and overall agreement 70%-83%, depending on age. Mean NPQ summary scores were lower than the BINS. Agreement varied depending on BINS risk status, being best in the high-risk group, and worst in the moderate risk group. Background variables had minimal impact at 6 and 12 months with BINS risk status being the primary influence; at 24-months, race, intraventricular hemorrhage, and respiratory distress syndrome were influential. Caretaker report is useful in a high-risk population, although the infant's neurodevelopmental status influences such early on; ethnic background and biomedical variables become more important at 2 years.
