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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Predicting school readiness from neurodevelopmental assessments at age 2 years after respiratory distress syndrome in
Athena I Patrianakos-Hoobler1, Michael E Msall, Dezheng Huo
1Department of Pediatrics, University of Chicago Comer Children's Hospital and LaRabida Children's Hospital, IL, USA.
Insights
Neurodevelopmental outcomes at age 2 accurately predict school readiness in preterm infants. Early identification of disability or delay is crucial for timely intervention and educational support.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Public health
Background:
- Preterm infants surviving respiratory distress syndrome (RDS) face long-term neurodevelopmental challenges.
- Early prediction of school readiness is vital for optimizing educational outcomes in this vulnerable population.
Purpose of the Study:
- To assess the predictive accuracy of neurodevelopmental outcomes at 2 years of age for school readiness in preterm infants who survived RDS.
- To identify factors influencing school readiness in this cohort.
Main Methods:
- A cohort of 121 preterm infants with RDS, treated with surfactant and ventilation, was followed.
- Neurodevelopmental outcomes at 2 years were categorized as 'disabled' or 'delayed' using standardized assessments.
- School readiness was evaluated at a mean age of 5 years 6 months through comprehensive neurodevelopmental assessments.
Main Results:
- At 2 years, 11% were classified as disabled and 23% as delayed.
- Disability at 2 years predicted lack of school readiness with 92% accuracy; delay predicted it with 50% accuracy.
- Only 15% of children with normal neurodevelopment at 2 years were not school ready; social disadvantage increased the need for special education.
Conclusions:
- Neurodevelopmental assessments at 2 years are strong predictors of school readiness in preterm survivors of RDS.
- Preterm survivors experiencing social disadvantage require targeted preschool developmental support to improve school readiness.
- Early identification and intervention are critical for improving long-term outcomes for preterm infants.
Aim:
To determine whether neurodevelopmental outcomes at the age of 2 years accurately predict school readiness in children who survived respiratory distress syndrome after preterm birth.
Method:
Our cohort included 121 preterm infants who received surfactant and ventilation and were enrolled in a randomized controlled study of inhaled nitric oxide for respiratory distress syndrome. Abnormal outcomes at the age of 2 years were defined as neurosensory disability (cerebral palsy, blindness, or bilateral hearing loss) or delay (no neurosensory disability but Bayley Scales of Infant Development mental or performance developmental index scores <70). School readiness (assessed at a mean age of 5y 6mo, SD 1y) was determined using neurodevelopmental assessments of motor, sensory, receptive vocabulary, perceptual, conceptual, and adaptive skills.
Results:
The mean birthweight of the cohort (57 males, 64 females) was 987g (SD 374), and the mean gestational age was 27.3 weeks (SD 2.6). At the age of 2 years, the neurodevelopmental classification was 'disabled' in 11% and 'delayed' in 23%. At the age of 5 years 6 months, intensive special education was required for 11% and some special education for 21%. Disability and delay at the age of 2 years were 92% and 50% predictive of lack of school readiness respectively, whereas only 15% of children who were normal at the age of 2 years were not school ready at the later assessment. Children with delay at 2 years were more likely to need special education if they were socially disadvantaged.
Interpretation:
Without preschool developmental supports, preterm survivors living in poverty will require more special education services.
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