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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Predicting neurodevelopmental impairment in preterm infants by standardized neurological assessments at 6 and 12
I Grimmer1, B C Metze, E Walch
1Department of Neonatology and Social Pediatrics, Charité University Medical Center, Berlin, Germany.
Insights
Early neurological exams in preterm infants have limited value for predicting neurodevelopmental impairment at 20 months. While the Early Motor Pattern Profile (EMPP) showed some correlation, it was less predictive than Griffiths scores at 6 and 12 months corrected age.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Pediatric neurodevelopment
Background:
- Diagnosing neurodevelopmental impairment in very preterm infants is typically reliable by 18-24 months corrected age.
- The predictive accuracy of earlier developmental assessments remains a subject of debate.
- Cerebral palsy and neurodevelopmental impairment are significant concerns in extremely preterm infants.
Purpose of the Study:
- To evaluate the hypothesis that neurological findings at 6 and 12 months corrected age can predict neurodevelopmental impairment at 18-24 months corrected age.
- To assess the predictive value of the Early Motor Pattern Profile (EMPP) for later neurodevelopmental outcomes.
- To compare the predictive power of the EMPP with Griffiths scales for identifying neurodevelopmental impairment.
Main Methods:
- A cohort of 561 preterm infants (birth weight <1500 g) underwent neurodevelopmental assessments.
- Griffiths scales were administered at 20 months corrected age.
- Standardized neurological examinations (EMPP) and Griffiths scales were performed at 6 and 12 months corrected age.
Main Results:
- Griffiths developmental quotients at 20 months showed a weak but significant correlation with EMPP scores at 6 (R(s) = 0.328) and 12 months (R(s) = 0.493).
- The EMPP's ability to predict neurodevelopmental impairment (Griffiths scores ≤75) at 20 months was moderate (AUC 0.772 at 6 months, 0.890 at 12 months), lower than Griffiths scores (AUC 0.915 at 6 months, 0.962 at 12 months).
- Both EMPP and Griffiths scores demonstrated high and comparable accuracy in predicting the inability to walk unaided at 2 years.
Conclusions:
- Neurological examinations using the EMPP at 6 and 12 months corrected age have limited predictive value for neurodevelopmental impairment at 20 months corrected age.
- Griffiths scales administered earlier show better predictive power for neurodevelopmental impairment than the EMPP.
- Both assessment tools are highly effective in predicting motor outcomes like unaided walking ability.
Aim:
Neurodevelopmental impairment in very preterm infants can be reasonably diagnosed by 18-24 months corrected age, whereas the predictive value of earlier assessments is debated. We hypothesized that neurological findings at 6 and 12 months indicative of subsequent cerebral palsy predict 18-24 months' neurodevelopmental impairment.
Methods:
Neurodevelopmental examinations (Griffiths scales) at 20 months of age in 561 preterm infants (birth weight <1 500 g) were compared with results of standardized neurological examinations (Early Motor Pattern Profile; EMPP) and Griffiths scales at 6 (n = 451) and 12 months (n = 496) corrected age.
Results:
Griffiths developmental quotients at 20 months were weakly but significantly related to EMPP scores at 6 (R(s) = 0.328) and 12 months (R(s) = 0.493). Areas under receiver operator characteristic curves for the EMPP to predict neurodevelopmental impairment (Griffiths scores
Conclusion:
Neurological examinations with the EMPP at 6 and 12 months corrected age are of limited value to predict neurodevelopmental impairment at 20 months.
