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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental and behavioral outcome of very low birth weight babies at corrected age of 2 years
Kanya Mukhopadhyay1, Prahbhjot Malhi, Rama Mahajan
1Department of Pediatrics, PGIMER, Chandigarh 160012, India. kanyapupul@yahoo.com
Insights
Very low birth weight (VLBW) babies require extended monitoring due to a high incidence of neurodevelopmental and behavioral issues. Early assessment is crucial for timely intervention and improved outcomes in these vulnerable infants.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Neuroscience
Background:
- Very low birth weight (VLBW) infants are at increased risk for adverse neurodevelopmental and behavioral outcomes.
- Long-term follow-up is essential to identify and manage potential developmental delays and abnormalities.
Purpose of the Study:
- To assess the neurodevelopmental and behavioral status of very low birth weight (VLBW) infants at 2 years corrected age (CA).
- To identify the prevalence of neurodevelopmental impairments and behavioral problems in VLBW infants.
Main Methods:
- A cohort of VLBW infants (≤34 weeks gestation and ≤1500g) were followed from 3 to 12 months CA for developmental and neurological assessments.
- The Developmental Assessment Scale for Indian Infants (DASII) was administered at 18 months CA, and the Preschool Behavioural Checklist (PBCL) at 2 years CA.
- Subgroup analyses were conducted based on birth weight (<1200g vs. 1201-1500g) and extremely low birth weight (<1000g).
Main Results:
- At 1 year CA, 3% of VLBW infants had Cerebral Palsy (CP), and 3% had suspect abnormalities. Significant gross motor (11%) and language (8%) abnormalities were also noted.
- Mean Mental (MeDQ) and Motor (MoDQ) quotients were 80.4±10.7 and 77.2±13.3, respectively, with 17% and 25.7% scoring below 70.
- A high PBCL score, indicative of behavioral issues, was observed in 84% of VLBW infants. Infants in the lowest birth weight subgroup (<1000g) showed higher rates of CP, low DQ scores, and behavioral problems.
Conclusions:
- VLBW infants exhibit a high prevalence of neurodevelopmental and behavioral abnormalities, necessitating close and extended follow-up.
- Early identification and intervention are critical for optimizing developmental trajectories in VLBW populations.
- The findings underscore the importance of comprehensive neurodevelopmental screening for VLBW infants beyond the neonatal period.
Objective:
Neurodevelopmental and behavioral assessment of very low birth weight babies (VLBW) at corrected age (CA) of 2 years.
Methods:
127, 110, 99 and 101 babies ≤34 weeks and ≤1500 g were followed at CA of 3, 6, 9, 12 months respectively for developmental and neurological assessment. DASII (Developmental assessment scale for Indian infants) was used at CA of 18 months and preschool behavioural checklist (PBCL) at CA 2 years.
Results:
Of 101 VLBW babies available for follow up at CA 1 year, 3 (3%) babies had Cerebral Palsy (CP) and 3% (n = 3) had suspect abnormality (mild hypotonia), 11% (n = 11) had gross motor and 8% (n = 8) had language abnormality. Their mean mental (MeDQ) and motor (MoDQ) quotients were 80.4 ± 10.7 and 77.2 ± 13.3 and a score of < 70 was found in 17% (MeDQ) and 25.7% (MoDQ) VLBW babies. High PBCL score (mean 16.8 ± 5.4) was seen in 84%VLBW babies. On subgroup analysis, 2 babies (5%) in subgroup1 ( n = 54, ≤1200 g,) and 1 (1.6%) in subgroup 2 (n = 78, 1201-1500 g) had CP. Twelve (29%) in subgroup 1 had significant language delay (p = 0.004) as compared to 4 (15%) in subgroup 2 at 1 year. BSID and PBCL scores were comparable. Amongst ELBW babies (<1000 g), 6.6% (n = 1) had CP, 25% (n = 3) and 42% (n = 5) had low MeDQ and MoDQ respectively and all of them had high PBCL score. AGA and SGA had similar outcome.
Conclusion:
VLBW babies need close and longer follow up due to high risk of neurodevelopmental and behavioral abnormality.
