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Prediction in very preterm infants of satisfactory neurodevelopmental progress at 12 months
A Stewart1, P L Hope, P Hamilton
1Department of Paediatrics, University College, London.
Insights
Combining ultrasound brain scans and neurological exams accurately predicts normal neurodevelopmental progress in very preterm infants. This combined approach offers a high probability of identifying infants who will develop typically by 12 months corrected age.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Preterm infants face increased risks of neurodevelopmental disorders.
- Early identification of neurodevelopmental outcomes is crucial for timely intervention.
- Predictive tools for neurodevelopmental progress in preterm infants are essential.
Purpose of the Study:
- To evaluate the predictive accuracy of ultrasound brain-scanning and neurological examination for neurodevelopmental progress in very preterm infants.
- To compare the combined versus separate predictive capabilities of these methods.
- To determine the probability of normal neurodevelopmental progress at 12 months corrected age.
Main Methods:
- A cohort of 111 infants born before 33 weeks gestation was studied.
- Ultrasound brain scans were performed at neonatal unit discharge.
- Neurological examinations were conducted near term-equivalent age.
- Repeated neurological and developmental testing occurred throughout the first year.
- Neurodevelopmental outcomes were assessed at 12 months corrected age.
Main Results:
- Infants with both favorable ultrasound scans and normal neurological exams had a 98% probability of normal progress at 12 months.
- This combined approach yielded a 100% probability of no major neurodevelopmental disorder.
- Individual methods (ultrasound or neurological exam alone) were less accurate predictors.
- The combined assessment identified a significant group of preterm infants with high likelihood of normal development.
Conclusions:
- Combined ultrasound brain-scanning and neurological examination effectively predict normal neurodevelopmental outcomes in very preterm infants.
- This integrated assessment strategy can identify preterm infants likely to achieve normal development upon discharge.
- The findings support the use of combined neuroimaging and clinical assessment for early risk stratification in preterm populations.
Abstract:
This study was performed to find out how well ultrasound brain-scanning and neurological examination of very preterm infants, together and separately, predicted normal neurodevelopmental progress at 12 months corrected age. 111 infants born at less than 33 weeks gestation were scanned at discharge from the neonatal unit, and neurological examinations were performed at a gestation-equivalent age at or near term. During the first year of life repeated neurological and developmental testing was carried out. At 12 months a diagnosis of normal progress or of major or minor neurodevelopmental disorders was made. 56 (50 per cent) infants with both a favourable ultrasound scan and normal neurological findings had a 98 per cent (90 to 99 per cent) probability of normal progress at 12 months, and a 100 per cent (93 to 100 per cent) probability of having no major disorder. Separately, ultrasound scanning and neurological examination were not such good predictors of normal outcome, although they selected larger groups of infants with high probabilities of progressing normally. Ultrasound brain-scanning and neurological examination can be used in combination to identify potentially normal preterm infants when they are discharged to their homes.