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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Late Preterm Infants and Neurodevelopmental Outcomes at Kindergarten
Melissa Woythaler1, Marie C McCormick2, Wen-Yang Mao3
1Massachusetts General Hospital for Children, Boston, Massachusetts; Harvard School of Medicine, Cambridge, Massachusetts; mwoythaler@partners.org.
Insights
Late preterm infants show increased risks for developmental delays. Early cognitive assessments at 24 months have limited predictive power for kindergarten readiness, though normal scores generally indicate continued normal development.
Area of Science:
- Neonatal development
- Pediatric neurodevelopmental outcomes
- Longitudinal cohort studies
Background:
- Late preterm infants (LPIs) face higher risks of mortality and morbidity compared to full-term infants (FTIs).
- Understanding the long-term neurodevelopmental trajectory of LPIs is crucial for early intervention and support.
Purpose of the Study:
- To assess neurodevelopmental outcomes in LPIs from infancy to school age.
- To determine the predictive value of early developmental testing for school readiness.
Main Methods:
- A longitudinal cohort study analyzed 4900 full-term and 950 late preterm infants.
- General estimating equations were used to calculate school readiness odds.
- Predictive values of 24-month Bayley MDI scores for kindergarten TSRS were generated.
Main Results:
- LPIs had significantly higher odds of poorer school readiness (aOR 1.52, P=.0215).
- The positive predictive value of a low 24-month MDI (<70) for poor kindergarten readiness was low (10.4%).
- A normal 24-month MDI (>70) had a high negative predictive value (96.8%) for normal kindergarten readiness.
Conclusions:
- LPIs remain at risk for developmental delays at kindergarten age.
- Early MDI scores have poor predictive validity for identifying children who will be in the bottom 5% at kindergarten.
- Infants with normal 24-month MDI scores have a high likelihood of maintaining normal development through kindergarten.
Background And Objective:
Late preterm infants (LPIs) (gestation 34 weeks and 0 days to 36 weeks and 6 days) compared with full-term infants (FTIs) are at increased risk for mortality and short- and long-term morbidity. The objective of this study was to assess the neurodevelopmental outcomes in a longitudinal cohort study of LPIs from infancy to school age and determine predictive values of earlier developmental testing compared with school-age testing.
Methods:
We used general estimating equations to calculate the odds of school readiness in a nationally representative cohort of 4900 full-term and 950 late preterm infants. We generated positive and negative predictive values of the ability of the 24-month Mental Developmental Index (MDI) scores of the Bayley Short Form, Research Edition, to predict Total School Readiness Score (TSRS) at kindergarten age.
Results:
In multivariable analysis, late preterm infants had higher odds of worse TSRSs (adjusted odds ratio 1.52 [95% confidence interval 1.06-2.18], P = .0215). The positive predictive value of a child having an MDI of <70 at 24 months and a TSRS <5% at kindergarten was 10.4%. The negative predictive value of having an MDI of >70 at 24 months and a TSRS >5% was 96.8%. Most infants improved score ranking over the study interval.
Conclusions:
LPIs continue to be delayed at kindergarten compared with FTIs. The predictive validity of having a TSRS in the bottom 5% given a MDI <70 at 24 months was poor. A child who tested within the normal range (>85) at 24 months had an excellent chance of testing in the normal range at kindergarten.
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