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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Lowering developmental screening thresholds and raising quality improvement for preterm children
Kevin Marks1, Hollie Hix-Small, Kathy Clark
1Department of Pediatrics, PeaceHealth Medical Group, 1162 Willamette, Eugene, OR 97401, USA. kmarks@peacehealth.org
Pediatrics
|June 2, 2009
Summary
Preterm children are more likely to be referred and eligible for early intervention services than term children. Implementing universal developmental screening, like the Ages and Stages Questionnaire (ASQ), improves early identification and intervention for ex-preemies.
Area of Science:
- Pediatric developmental surveillance and screening
- Early intervention services
- Child development outcomes
Background:
- Preterm children often require early intervention (EI) and early childhood special education (ECSE) services.
- A universal, periodic Ages and Stages Questionnaire (ASQ) surveillance and screening system was implemented.
- Assessing referral and identification rates for preterm versus term children is crucial.
Purpose of the Study:
- To compare EI/ECSE referral and service rates between preterm and term children post-ASQ implementation.
- To evaluate if pediatricians adjusted screening thresholds for preterm infants.
- To identify quality improvement opportunities in developmental surveillance and referral.
Main Methods:
- Secondary analysis of 64 lower-risk preterm and 1363 term children at 12- or 24-month well-visits.
- Exclusion of higher-risk preemies already in EI.
- Comparison of Pediatric Developmental Impression and ASQ referral rates; medical record review for EI/ECSE outcomes up to 60 months.
Main Results:
- Preterm children showed higher referral rates with ASQ (26.2%) versus Pediatric Developmental Impression (9.5%) compared to term children (8.1% vs 5.6%).
- By 36-60 months, 37.5% of preterm children were referred to EI/ECSE, with 50% eligible, and 54.2% identified with developmental-behavioral disorders.
- Preterm children were twice as likely to be eligible for services than term children.
Conclusions:
- Clinicians should lower screening thresholds for preterm infants during developmental surveillance.
- The ASQ system enhances the identification of developmental delays in ex-preemies.
- Opportunities exist for improving the referral process for early intervention services.
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