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CDC Kerala 3: At-risk baby clinic service using different screening tools--outcome at 12 months using Developmental
M K C Nair1, Rajee Krishnan, G S Harikumaran Nair
1Child Development Centre, Thiruvananthapuram Medical College, Thiruvananthapuram, 695011, Kerala, India, cdcmkc@gmail.com.
Insights
This study evaluated developmental screening tools for at-risk infants at 12 months. While some tools showed high specificity, they had low sensitivity for detecting developmental delays compared to the gold standard Developmental Assessment Scale for Indian Infants (DASII).
Area of Science:
- Pediatrics
- Developmental Pediatrics
- Neonatal Follow-up
Background:
- Establishing follow-up clinics for high-risk infants, particularly NICU graduates, is crucial for early detection of developmental delays.
- Developmental assessment at 12 months corrected age is a critical milestone for identifying potential neurodevelopmental impairments.
Purpose of the Study:
- To describe the experience of establishing an at-risk baby clinic at CDC Kerala.
- To compare the efficacy of various developmental screening tools at 12 months corrected age against the gold standard Developmental Assessment Scale for Indian Infants (DASII).
Main Methods:
- An at-risk baby clinic was established for NICU graduates, with follow-up visits at 2, 4, 6, 8, and 12 months corrected age.
- Mothers received training on early stimulation techniques based on the CDC model.
- At 12 months, four simple developmental screening tools were compared with the DASII, administered by a senior developmental therapist.
Main Results:
- Out of 800 infants, 604 had outcome data at 12 months.
- Prevalence of developmental delay was 24.8% (CDC standing), 24% (Amiel Tison angles), and 24.3% (DDST II gross motor), versus 13.3% with DASII.
- A combination of screening tools showed high specificity (94.15%) and NPV (70.18%) but low sensitivity (14.58%) and PPV (53.85%) against DASII motor DQ.
- Neonatal seizures and low birth weight were significant risk factors for DASII mental deviation quotient (DQ).
Conclusions:
- The screening tools (CDC grading for standing, Amiel Tison angles, DDST II gross motor) demonstrated high specificity, NPV, and accuracy when compared to the DASII motor DQ at one year.
- Despite high specificity, the low sensitivity of these screening tools indicates a potential for missed diagnoses.
- The findings highlight the need for careful selection and interpretation of developmental screening tools in at-risk infant populations.
Objectives:
To describe CDC Kerala experience of establishing an at-risk baby clinic and the comparison of different developmental screening tools at 12 mo against the gold standard Developmental Assessment Scale for Indian Infants (DASII).
Methods:
At risk baby clinic of CDC, Kerala was established as a facility for follow up of NICU graduates from Sree Avittam Thirunal Hospital at 2, 4, 6, 8 and 12 mo corrected age and during each visit the mother is taught the CDC model early stimulation by developmental therapists and encouraged to continue to do the same at home. At 12 mo, assessment results of four simple developmental tools were compared with the gold standard DASII administered by a senior developmental therapist.
Results:
Out of a total of 800 babies, outcome measurements at 12 mo were available for 604 infants. The prevalence of developmental delay using the screening tools, CDC grading for standing, Amiel Tison angles and DDST II (Denver II) gross motor were 24.8, 24 and 24.3% respectively and using DASII, a diagnostic tool (13.3%). Also the combination of Amiel Tison angles, CDC standing grading and DDST gross motor against DASII motor DQ had high specificity (94.15%) and negative predictive value (NPV) (70.18%) but with a very low sensitivity of 14.58% and low positive predictive value (PPV) of 53.85%. It was observed that a significant odds ratio for DASII mental deviation quotient (DQ) was seen for neonatal seizures (2.34) and low birth weight (1.49).
Conclusion:
The prevalence of developmental delay using the screening tools, CDC grading for standing, Amiel Tison angles and DDST II (Denver II) gross motor were 24.8, 24 and 24.3% respectively and together they had a high specificity, NPV and accuracy against DASII motor DQ as gold standard at one year assessment.