Clinical tools used in young infants born very preterm to predict motor and cognitive delay (not cerebral palsy): a systematic review
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Rebecca Caesar1,2, Paul B Colditz2,3, Giovanni Cioni4
1Allied Health Women's and Families Service, Sunshine Coast Hospital and Health Service District, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
Insights
Predicting motor and cognitive delays in very preterm infants is crucial. The General Movement Assessment (GMA) and Hammersmith Infant Neurological Examination (HINE) show promise for early detection at 6 months corrected age.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Diagnostic accuracy studies
Background:
- Infants born very preterm are at high risk for motor and cognitive delays.
- Accurate prediction of these delays at an early corrected age is essential for timely intervention.
- Current predictive tools require rigorous evaluation for their efficacy in this population.
Purpose of the Study:
- To systematically review the accuracy of clinical tools used at 6 months corrected age or younger to predict motor and cognitive delay at 24 months corrected age in very preterm infants.
- To identify the most reliable assessment tools for early detection of neurodevelopmental impairments.
Main Methods:
- Systematic review of six databases.
- Quality assessment using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.
- Bivariate meta-analysis and receiver operating characteristic (ROC) curve analysis to evaluate predictive accuracy.
Main Results:
- Six assessments from 10 studies involving 992 infants were analyzed.
- The General Movement Assessment (GMA) demonstrated good accuracy in predicting mild, moderate, and severe motor and cognitive delays.
- The Hammersmith Infant Neurological Examination (HINE) showed excellent accuracy for severe motor delay but limited ability for milder delays.
Conclusions:
- Few tools accurately predict motor and cognitive delays in very preterm infants by 6 months corrected age.
- Both GMA and HINE show predictive validity, with GMA being effective for a broader range of delays and HINE excelling in identifying severe motor delay.
Aim:
This systematic review evaluates the accuracy of clinical tools used at a corrected age of 6 months or younger to predict motor and cognitive delay (not cerebral palsy) at 24 months' corrected age, in infants born very preterm.
Method:
Six databases were searched. Quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. Predictive analysis included calculation of sensitivity and specificity, inspection of summary receiver operating characteristics curves, and bivariate meta-analysis.
Results:
Six assessments were identified in 10 studies of 992 infants. Overall prevalence of motor delay was 13.8% and cognitive delay was 11.7%. Methodological quality was variable for patient selection, reference standard, flow, and timing. All studies had a low risk of bias for the index test. General Movement Assessment (GMA) predicted motor and cognitive outcomes with good accuracy for mild, moderate, and severe delays (fidgety age: pooled diagnostic odds ratio=12.3 [5.9-29.8]; hierarchical summary receiver operating characteristics curve=0.733). The Hammersmith Infant Neurological Examination (HINE) demonstrated excellent predictive accuracy for severe motor delay (3mo and 6mo; sensitivity 93% [68-100%], specificity 100% [96-100%]) but showed limited ability to predict milder delays.
Interpretation:
In the population of infants born very preterm, few assessment tools used at 6 months or younger corrected age have proven predictive accuracy for cognitive and motor delay at 24 months' corrected age. Only the GMA and HINE demonstrated useful predictive validity.
What This Paper Adds:
General movements have predictive validity for both motor and cognitive dysfunction in infants born very preterm. The Hammersmith Infant Neurological Examination showed the highest predictive accuracy for severe motor delay. The General Movement Assessment was the best tool to predict mild-to-moderate motor and cognitive delays.
