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Developmental Assessments in Preterm Children: A Meta-analysis
Hilary S Wong1, Shalini Santhakumaran2, Frances M Cowan3
1Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom; and.
Insights
Early developmental assessments show poor sensitivity but good specificity in predicting school-age cognitive deficits in children born very preterm or with very low birth weight.
Area of Science:
- Pediatrics
- Developmental Psychology
- Neuroscience
Background:
- Outcomes for very preterm or very low birth weight children are often assessed before age 3.
- The predictive validity of these early assessments for later outcomes remains uncertain.
Purpose of the Study:
- To evaluate the accuracy of early developmental assessments in predicting cognitive deficits at school age.
- To determine the validity of serial developmental assessments in at-risk children.
Main Methods:
- A systematic review and meta-analysis of English-language studies was conducted.
- Included studies reported at least two serial assessments (one between 1-3 years, one at ≥5 years).
- Sensitivity, specificity, and predictive values were calculated for early assessments predicting school-age cognitive deficits.
Main Results:
- Twenty-four studies involving 3133 children were analyzed.
- Early assessments (18-40 months) had pooled sensitivity of 55.0% and specificity of 84.1% for school-age cognitive deficit.
- Positive predictive values ranged from 20.0% to 88.9%, and negative predictive values ranged from 47.8% to 95.5%.
Conclusions:
- Early developmental assessments demonstrate low sensitivity but high specificity for identifying school-age cognitive deficits.
- These findings suggest that while early assessments are not highly sensitive, they are reasonably good at ruling out future cognitive deficits.
Context:
Developmental outcomes of very preterm (gestational age ≤32 weeks) or very low birth weight (<1500 g) children are commonly reported before age 3 years although the predictive validity for later outcomes are uncertain.
Objective:
To determine the validity of early developmental assessments in predicting school-age cognitive deficits.
Data Sources:
PubMed.
Study Selection:
English-language studies reporting at least 2 serial developmental/cognitive assessments on the same population, 1 between ages 1 and 3 years and 1 at ≥5 years.
Data Extraction:
For each study, we calculated the sensitivity, specificity, and positive and negative predictive values of early assessment for cognitive deficit (defined as test scores 1 SD below the population mean). Pooled meta-analytic sensitivity and specificity were estimated by using a hierarchical summary receiver operator characteristic curve.
Results:
We included 24 studies (n = 3133 children). Early assessments were conducted at 18 to 40 months and generally involved the Bayley Scales of Infant Development or the Griffiths Mental Development Scales; 11 different cognitive tests were used at school-age assessments at 5 to 18 years. Positive predictive values ranged from 20.0% to 88.9%, and negative predictive vales ranged from 47.8% to 95.5%. The pooled sensitivity (95% confidence interval) of early assessment for identifying school-age cognitive deficit was 55.0% (45.7%-63.9%) and specificity was 84.1% (77.5%-89.1%). Gestational age, birth weight, age at assessment, and time between assessments did not explain between-study heterogeneity.
Limitations:
The accuracy of aggregated data could not be verified. Many assessment tools have been superseded by newer editions.
Conclusions:
Early developmental assessment has poor sensitivity but good specificity and negative predictive value for school-age cognitive deficit.
