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Measuring sensorineural disability in preterm children using a public health screening strategy: a randomised
Margo A Pritchard1, Paul B Colditz, David I Tudehope
1Perinatal Research Centre, Royal Brisbane and Women's Hospital, The University of Queensland, Australia. m.pritchard@uq.edu.au
Insights
A new preterm-targeted screening program did not improve overall disability detection in very preterm infants compared to the standard NHMRC program. However, it showed higher sensitivity in identifying children with disabilities.
Area of Science:
- Pediatrics
- Public Health
- Developmental Pediatrics
Background:
- Early detection of disability in preterm infants is crucial for timely intervention.
- Existing universal screening programs may not adequately identify all neurodevelopmental challenges in this high-risk population.
- General practice settings are key points for child health surveillance.
Purpose of the Study:
- To compare the efficacy of a preterm-targeted screening program against the routine Australian National Health Medical Research Council (NHMRC) universal screening program.
- To assess the ability of general practitioners to detect disability in preterm infants at 12 months corrected age.
- To evaluate secondary outcomes including parental mental health and service utilization.
Main Methods:
- A multi-centered randomized trial involving 202 preterm infants (born ≤31 weeks gestation).
- Infants were randomized to either the preterm-targeted or NHMRC screening program.
- Primary outcome was correct identification of neurosensory disability by general practitioners, validated against gold-standard pediatric assessments.
Main Results:
- No significant difference in overall disability identification between the preterm-targeted (65.6%) and NHMRC (67.6%) groups.
- The preterm-targeted program demonstrated higher sensitivity (73% vs. 33%) but lower specificity (70% vs. 92%), leading to more over-referrals.
- Postnatal depression scores were higher in the preterm-targeted group.
Conclusions:
- The preterm-targeted screening program did not improve overall disability identification rates compared to the NHMRC universal program.
- Despite not improving overall detection, the preterm-targeted program showed greater efficacy as a screening tool for accurately identifying disabled children.
- Further research may be needed to optimize screening protocols for preterm infants in primary care settings.
Aim:
To assess the efficacy of a preterm-targeted screening programme against the routine Australian National Health Medical Research Council (NHMRC) universal child health screening programme to detect disability in a general practice setting in children born < or =31 weeks gestation at 12-months of age.
Methods:
Multi-centred trial involving 202 preterm children randomised to receive the preterm-targeted or NHMRC programme. Primary outcome, correct identification of neurosensory disability by general practitioners assessed against gold standard paediatric assessments. Sensitivity analysis estimated interrater agreement and screening accuracy. Secondary outcomes, post natal depression (PND), parental stress, health service use, screening programme helpfulness and correct identification of levels of disability severity.
Results:
Of the 195 infants with data on the primary outcome in the preterm-targeted group, their general practitioners correctly identified the disability status of 61/93 (65.6%) children, as compared with 69/102 (67.6%) in the NHMRC group (odds ratios (OR) 0.91 95% confidence interval (CI) 0.50, 1.65). Responses where general practitioners were unsure of a child's disability status were coded as incorrect and not paired for sensitivity analysis. Sensitivity analysis for 180 diagnostic pairs showed fair interrater agreement for both groups (preterm-targeted k = 0.30 vs. NHMRC k = 0.29) with screening test results favouring the preterm-targeted group with greater sensitivity (73% vs. 33%) but lower specificity (70% vs. 92%) resulting in more over referrals (30% vs. 8%); however, these had a significantly lower mean Developmental Quotient (DQ) score compared with non-disabled children. PND scores were higher in preterm-targeted group (OR 1.33 95% CI 0.01, 2.66).
Conclusion:
The preterm-targeted programme used by general practitioners: (i) did not improve overall identification of disability status compared to the NHMRC universal programme (Australian New Zealand Clinical Trails Registry number, ACTRN 12606000472572); however (ii) it did demonstrate greater efficacy as a screening tool in accurately identifying disabled children.
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