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The Ages and Stages Questionnaire and Neurodevelopmental Impairment in Two-Year-Old Preterm-Born Children
Jorien M Kerstjens1, Ard Nijhuis1, Christian V Hulzebos1
1Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands.
Insights
The Ages and Stages Questionnaire (ASQ3) effectively screens very preterm children for neurodevelopmental impairment (NDI) at two years. A negative ASQ3 result reliably excludes NDI, demonstrating its value in early identification.
Area of Science:
- Neonatal care and developmental pediatrics.
- Child development and screening methodologies.
Background:
- Very preterm infants (<32 weeks) are at high risk for neurodevelopmental impairment (NDI).
- Accurate and timely identification of NDI is crucial for early intervention and improved outcomes.
- Existing screening tools require validation in this specific high-risk population.
Purpose of the Study:
- To evaluate the efficacy of the Ages and Stages Questionnaire, Third Edition (ASQ3) in identifying or excluding neurodevelopmental impairment (NDI).
- To assess ASQ3's performance in very preterm-born children at a corrected age of two years.
Main Methods:
- A cohort of 224 very preterm infants (<32 weeks) were assessed at 22-26 months corrected age.
- ASQ3 scores were compared with neurodevelopmental assessments using Bayley Scales of Infant and Toddler Development, Third Edition (BSIDIII) and neurological examinations.
- Neurodevelopmental impairment (NDI) was defined by BSIDIII scores (<70), neurological examination, or audiovisual screening, with adjusted BSIDIII thresholds (<80, <85) also analyzed.
Main Results:
- None of the 163 children (73%) who passed the ASQ3 exhibited NDI, yielding a 100% negative predictive value (NPV).
- ASQ3 demonstrated excellent sensitivity (100%) and acceptable specificity (76%) for detecting NDI.
- High sensitivity and NPV were maintained even with adjusted BSIDIII thresholds.
Conclusions:
- The ASQ3 is a valid and cost-effective screening tool for identifying and excluding NDI in very preterm children at two years corrected age.
- ASQ3's high NPV makes it particularly useful for ruling out NDI, simplifying follow-up assessments.
Objective:
To test the ability of the Ages and Stages Questionnaire, Third Edition (ASQ3) to help identify or exclude neurodevelopmental impairment (NDI) in very preterm-born children at the corrected age of two.
Methods:
We studied the test results of 224 children, born at <32 postmenstrual weeks, who had scores on ASQ3 and Bayley Scales of Infant and Toddler Development, Third Edition (BSIDIII) and neurological examination at 22-26 months' corrected age. We defined NDI as a score of <70 on the cognitive--or motor composite scale of BSIDIII, or impairment on neurological examination or audiovisual screening. We compared NDI with abnormal ASQ3 scores, i.e., < -2SDs on any domain, and with ASQ3 total scores. To correct for possible overestimation of BSIDIII, we also analyzed the adjusted BSIDIII thresholds for NDI, i.e., scores <80 and <85.
Results:
We found 61 (27%) children with abnormal ASQ3 scores, and 10 (4.5%) children who had NDI with original BSIDIII thresholds (<70). Twelve children had NDI at BSIDIII thresholds at <80, and 15 had <85. None of the 163 (73%) children who passed ASQ3 had NDI. The sensitivity of ASQ3 to detect NDI was excellent (100%), its specificity was acceptable (76%), and its negative predictive value (NPV) was 100%. Sensitivity and NPV remained high with the adjusted BSIDIII thresholds.
Conclusion:
The Ages and Stages Questionnaire is a simple, valid and cost-effective screening tool to help identify and exclude NDI in very preterm-born children at the corrected age of two years.
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