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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neonatal assessments for the preterm infant up to 4 months corrected age: a systematic review
1Physiotherapy Department, Royal Children's Hospital, Brisbane, Australia. yolande_noble@health.qld.gov.au
Insights
This review evaluated neonatal neurobehavioral and neuromotor assessments for preterm infants. The General Movements (GMs) assessment showed the best prediction of future outcomes.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Clinical assessment
Background:
- Preterm infants require specialized neurodevelopmental assessments.
- Longitudinal assessments are crucial for tracking development and predicting outcomes.
- Existing neurobehavioral and neuromotor tools vary in their clinimetric properties.
Purpose of the Study:
- To systematically review the clinimetric properties of longitudinal neonatal neurobehavioral and neuromotor assessments.
- To identify the most reliable and valid tools for preterm infants.
- To compare the utility of different assessments in research and clinical settings.
Main Methods:
- Systematic review of 27 identified assessment measures.
- Inclusion criteria focused on neurobehavioral/neuromotor assessments for preterm infants up to 4 months corrected age, suitable for longitudinal use, and discriminative, predictive, or evaluative.
- Eight measures met criteria: APIB, NNNS, TIMP, GMs, NAPI, Dubowitz, NMBA, and NBAS.
Main Results:
- All included measures demonstrated adequate content and construct validity.
- Predictive validity was high for General Movements (GMs), with 100% sensitivity for predicting cerebral palsy.
- Interrater reliability was strong for TIMP and GMs, and moderate for NAPI.
Conclusions:
- NNNS and APIB offer strong psychometric qualities for research.
- GMs, TIMP, and NAPI possess strong psychometric qualities for clinical settings.
- GMs excel in predicting future outcomes, while TIMP demonstrates the best evaluative validity.
Aim:
The aim of this study was to systematically review the clinimetric properties of longitudinal neonatal neurobehavioural and neuromotor assessments for preterm infants.
Method:
Twenty-seven assessment measures were identified. The following eight measures met the study inclusion criteria: Assessment of Preterm Infants' Behaviour (APIB), Neonatal Intensive Care Unit Network Neurobehavioural Scale (NNNS), Test of Infant Motor Performance (TIMP), Prechtl's Assessment of General Movements (GMs), Neurobehavioural Assessment of the Preterm Infant (NAPI), Dubowitz Neurological Assessment of the Preterm and Full-term Infant (Dubowitz), Neuromotor Behavioural Assessment (NMBA), and the Brazelton Neonatal Behavioural Assessment Scale (NBAS). The primary purposes included prediction (TIMP, GMs, Dubowitz), discrimination (all assessments), and evaluation of change (TIMP, NAPI). Measures of assessment were included in the study if they were (1) primarily neurobehavioural or neuromotor assessments that were suitable for use with preterm infants (<37 weeks gestation) up to 4 months corrected age and were discriminative, predictive, or evaluative; (2) standardized procedures designed for serial/longitudinal use; or (3) criterion or norm referenced. However, all assessment tools that were not published in English in a peer-reviewed journal or were primarily neurological assessments, one-time evaluations, screening tools, or not commercially available were not used.
Results:
All of the measures included in the review demonstrated adequate content and construct validity. Concurrent validity was reported for APIB, NNNS, Dubowitz, and GMs. Predictive validity was high for GMs with studies reporting up to 100% senstivity for predicting cerebral palsy at the age of 12 to 24 months. Interrater reliability was strong for the TIMP (intraclass correlation=0.95), GMs (K=0.8), and moderate for the NAPI (r=0.67-0.97). Clinical utility was variable for ease of scoring, interpretability, cost, and access.
Interpretation:
In the absence of a criterion standard for neonatal neuromotor assessments, the NNNS and APIB have strong psychometric qualities with better utility for research. Similarly, the GMs, TIMP, and NAPI have strong psychometric qualities but better utility for clinical settings. The GMs has best prediction of future outcome and the TIMP has best evaluative validity.
