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Updated: Mar 6, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Prognostic neurodevelopmental testing of preterm infants: do we need to change the paradigm?
H W Kilbride1, G P Aylward2, L W Doyle3
1Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Insights
Routine developmental assessments for high-risk newborns at two years offer insights for interventions. However, these early outcomes have limitations and may not predict long-term function, emphasizing environmental influences.
Area of Science:
- Neonatal Development
- Pediatric Neurodevelopment
- High-Risk Infant Care
Background:
- Longitudinal follow-up assessments at approximately two years of age are standard practice for high-risk newborns.
- These assessments serve multiple functions, including guiding educational and developmental interventions for physicians, parents, and educators.
- They also function as crucial outcome measures in clinical research and inform counseling for parents of extremely preterm infants.
Purpose of the Study:
- To evaluate the utility and limitations of current neurodevelopmental assessment tools for high-risk infants at two years of age.
- To discuss the appropriate use of outcome metrics based on the intended purpose of the assessment.
- To highlight the need for considering factors beyond early developmental status in predicting long-term outcomes.
Main Methods:
- Review of current practices and literature regarding developmental assessments in high-risk newborns.
- Analysis of the predictive value of early developmental outcomes for later-life function.
- Consideration of the role of environmental factors in long-term cognitive and academic development.
Main Results:
- Early developmental assessments have limitations and do not always accurately predict later-life function.
- Individual variation in outcomes is significant, with early results serving as estimates of longer-term trajectories.
- Postnatal environmental factors are predominant in determining cognitive and academic outcomes for infants without severe neurological injury.
Conclusions:
- The purpose of testing should guide the selection of outcome metrics, with descriptive findings being more useful for individual intervention planning.
- Composite categorization of findings is best reserved for research purposes.
- Future research should incorporate quality of life and parental decision-making factors relevant to neonatal intensive care unit (NICU) care.
Abstract:
Longitudinal follow-up with assessment of developmental status at about 2 years of age is routine for high-risk newborns. The results of these assessments can be used for many purposes, including helping physicians, parents, and teachers plan educational or developmental interventions. These assessments also provide outcome measures for clinical research studies. Outcome results may also serve as a source of information for clinicians when counseling parents regarding provision of care for extreme preterm infants. Consideration should be given to use of different outcome metrics based on the purpose for testing. Categorization of composite cognitive, motor and neurosensory findings to define levels of impairment should be limited to research. Planning for individual interventions is better guided by descriptive findings. Current tools for assessing neurodevelopmental status at 2 years of age have important limitations. First, outcomes at early ages do not always predict function later in life. They are, at best, an estimate of longer-term outcomes, with important individual variation. For infants without severe neurologic injury, postnatal environmental factors play a predominant role in determining long-term cognitive and academic outcomes. Further investigations should assess quality of life and other considerations that are important for parents when making decisions about neonatal intensive care unit care for their infant.
