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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Does the individualized reference outperform a simple ultrasound-based reference applied to birth weight in
G Neta1, J Grewal, R Mikolajczyk
1Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD 20852, USA. netagil@mail.nih.gov
Insights
An individualized reference for small-for-gestational age (SGA) better predicts poor neurodevelopment in children than simple ultrasound methods. However, neither approach reliably identifies infants at risk for cognitive deficits.
Area of Science:
- Pediatrics
- Neonatology
- Developmental Psychology
Background:
- Small-for-gestational age (SGA) is linked to increased morbidity, but optimal diagnostic methods for predicting adverse outcomes remain unclear.
- Accurate identification of SGA infants is crucial for timely intervention and improved health outcomes.
- Cognitive development in early childhood is a key indicator of long-term well-being.
Purpose of the Study:
- To compare an individualized reference for defining SGA with simple birth weight-based and ultrasound-based references.
- To evaluate the predictive accuracy of these references for poor cognitive development at age five.
- To determine the relative risk of neurodevelopmental issues associated with SGA classifications.
Main Methods:
- Prospective Successive SGA Births Study data (699 Alabama, 618 Scandinavian women).
- Cognitive development assessed at age five using Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) IQ scores.
- Sensitivity, specificity, positive predictive value (PPV), and relative risk (RR) calculated for each SGA reference.
Main Results:
- The individualized reference demonstrated higher specificity and PPV for predicting poor neurodevelopment.
- Infants identified as SGA by the individualized reference alone showed a higher risk of poor cognitive outcomes (RR=2.20).
- Infants identified by the ultrasound-based reference alone did not show a significantly increased risk (RR=0.95).
Conclusions:
- An individualized birth weight reference offers modest improvement over simple ultrasound methods in identifying SGA infants with poor neurodevelopmental outcomes.
- Current diagnostic references for SGA have limited ability to predict cognitive development accurately at age five.
- Further research is needed to develop more precise methods for identifying SGA infants at risk for developmental delays.
Objectives:
Being small-for-gestational age (SGA) is associated with an increased risk of morbidity, but questions remain about how best to diagnose SGA, and thus, predict poor health consequences. The authors sought to compare an individualized reference for defining SGA with simple birth weight-based and ultrasound-based references applied to birth weight in predicting poor cognitive development at age five.
Methods:
The authors used data from the Successive SGA Births Study, a prospective study including 699 Alabaman and 618 Scandinavian women recruited from 1986 to 1988, and whose children had cognitive development scores measured at age five using the Wechsler Preschool and Primary Scale of Intelligence-Revised Intelligence Quotient. Sensitivity, specificity and positive predictive value (PPV) were estimated for each reference applied to birth weight using adverse cognitive development (score < 10(th) percentile) as the outcome. Relative risk of poor neurodevelopment was calculated, comparing infants classified as SGA by either the individualized or the simple ultrasound-based reference with infants not classified as SGA.
Results:
The individualized reference had higher specificity and PPV in predicting poor neurodevelopment. Neonates defined as SGA by the individualized reference alone had a higher risk (RR=2.20, 95% CI: 1.20, 4.00) of poor cognitive outcome, while those identified by the ultrasound-based reference alone did not (RR=0.95, 95% CI: 0.45, 2.01). None of the references could predict poor neurodevelopment well at age five.
Conclusions:
The individualized birth weight reference modestly outperforms the simple ultrasound-based reference in identifying SGA infants with poor child neurodevelopment. However, neither reference can predict child neurodevelopment well.
