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Predictive validity of the Lacey Assessment of Preterm Infants for motor outcome at 2 years corrected age
Anna M Lukens1, Naomi R Winfield2, Charlotte A Xanthidis3
1Children's Neurosciences, Evelina London Children's Hospital, Guys' and St Thomas' NHS Trust, London, UK; Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
Insights
The Lacey Assessment of Preterm Infants (LAPI) has high specificity but low sensitivity in predicting motor delays in preterm infants. Ongoing monitoring is advised for infants screened with LAPI.
Area of Science:
- Neonatal development
- Pediatric neurology
- Clinical assessment tools
Background:
- Preterm infants are at high risk for neuromotor developmental problems.
- Early identification and intervention are crucial for optimizing outcomes.
- The Lacey Assessment of Preterm Infants (LAPI) is a tool used to assess neuromotor development.
Purpose of the Study:
- To determine the predictive validity of the LAPI for motor outcomes at 2 years corrected age.
- To evaluate the LAPI's effectiveness in identifying preterm infants needing early intervention.
- To optimize developmental outcomes for high-risk preterm infants.
Main Methods:
- Retrospective review of LAPI outcomes for preterm infants (born 2012-2017).
- Comparison of LAPI classifications (usual/monitor) with motor scores from Griffiths Mental Development Scales-Extended Revised (GMDS-ER) or Griffiths III at 2 years corrected age.
- Analysis of predictive validity for moderate/severe motor delay.
Main Results:
- 118 infants were included in the study.
- Infants classified as 'usual' on LAPI had significantly less motor delay (2.00 months) compared to the 'monitor' group (6.00 months) (p=0.001).
- The LAPI demonstrated a sensitivity of 47.37% and a specificity of 84.85% for predicting motor delay.
Conclusions:
- The LAPI exhibits high specificity but low sensitivity in predicting later motor delay in preterm infants.
- The LAPI may be beneficial for screening lower-risk infants, but ongoing monitoring is recommended.
- Further research is needed to improve LAPI's sensitivity, potentially by combining it with other predictive tools.
Introduction:
The Lacey Assessment of Preterm Infants (LAPI) is a clinical tool used to assess neuromotor development in preterm infants at high risk of developmental problems. The aim of this study was to determine its predictive validity for estimating later motor outcome at 2 years of age, to ensure appropriate referral to early intervention and thus optimise the infant's outcome.
Method:
LAPI outcomes (usual or monitor) for preterm infants born between January 2012-2017 at a single tertiary level neonatal intensive care unit in London, UK were retrospectively reviewed. Predictive validity for later "moderate/severe" motor delay was determined by comparing LAPI outcomes with locomotor scores estimated using the Griffiths Mental Development Scales-Extended Revised (GMDS-ER) or Griffiths III at 2 years corrected age.
Results:
118 infants were included (GMDS-ER = 87, Griffiths III = 31). Infants classified as usual on the LAPI showed significantly less motor delay on the GMDS-ER locomotor subset at 2 years, compared to infants in the monitor group (usual = 2.00 months, monitor = 6.00 months; p = 0.001). Sensitivity was found to be only 47.37%, with higher specificity of 84.85%.
Conclusion:
The LAPI shows high specificity but low sensitivity for prediction of later motor delay. It may therefore be useful for screening lower-risk infants, however on-going monitoring would be advised. Further studies investigating the reliability of the LAPI and use in conjunction with other predictive tools to improve sensitivity are recommended.
