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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Effectiveness of Bedside Clinical Screening Tools in Predicting Short-Term Neurodevelopmental Delay Among
Jacquilyne Kharlukhi1, Udayakumar Narasimhan2, Saji James2
1Pediatrics, Sree Balaji Medical College and Hospital, Chennai, IND.
Insights
Early detection of neurodevelopmental delay in very-low-birth-weight (VLBW) preterm infants is crucial. The Hammersmith Neonatal Neurological Examination (HNNE) combined with MRI shows high accuracy for predicting long-term outcomes.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Neuroimaging
Background:
- Preterm birth, especially in very-low-birth-weight (VLBW) infants, significantly increases the risk of neurological morbidities.
- Early detection and intervention are vital for mitigating long-term adverse outcomes.
- Resource-limited settings face challenges with uniformly available clinical and radiological screening tools.
Purpose of the Study:
- To evaluate the validity of clinical screening tools for detecting neurodevelopmental delay in VLBW preterm infants.
- To assess the effectiveness of these tools in resource-poor settings.
Main Methods:
- Prospective observational study of VLBW preterm neonates admitted to a tertiary care hospital.
- Hammersmith Neonatal Neurological Examination (HNNE) and brain MRI at term-equivalent age.
- Follow-up assessments at eight months corrected age using Amiel-Tison (AT) angles, Child Development Centre (CDC) grading, and Denver Development Screening Test (DDST-II gross motor).
Main Results:
- HNNE at term-equivalent age demonstrated high sensitivity (93.6%) and positive predictive value (91.2%) when compared to MRI as the gold standard.
- Follow-up tools like CDC grading, AT angles, and DDST-II showed high sensitivity (>85%) for detecting developmental risks.
- Abnormalities were detected in 17.9% by HNNE, 13.8% by AT angles, 35.2% by CDC grading, and 30.4% by DDST-II.
Conclusions:
- Combining HNNE with radiological assessment at term-corrected age is effective for predicting long-term neurodevelopmental outcomes in VLBW preterm infants.
- Simple follow-up tools (CDC, AT angles, DDST-II) are valuable in resource-poor settings where standard assessments are unavailable.
Background:
Pre-term births are associated with increased risk of various morbidities, especially neurological. Early detection and early intervention to prevent these morbidities will have immediate and long-term benefits to the individuals and society at large. However, the screening and assessment tools, including both clinical and radiological, are not uniformly available in resource-poor settings. The present study was carried out to evaluate the validity of the clinical screening tools for detecting neurodevelopmental delay among very-low-birth-weight (VLBW) pre-term babies.
Methods:
This prospective observational study was undertaken in the child development unit of a tertiary care hospital from July 2015 to October 2017. All pre-term VLBW neonates admitted in level III Neonatal Intensive Care within the first 24 hours of life were included in the study. They were subjected to Hammersmith Neonatal Neurological Examination (HNNE) and magnetic resonance imaging (MRI) of brain at term-equivalent age. Subsequently, the same group was followed up with Amiel-Tison (AT) angles, Child Development Centre (CDC) grading for sitting developed at Trivandrum, Kerala, India, and Denver Development Screening Test (DDST-II gross motor) at eight months corrected age, and their outcomes were analyzed.
Results:
17.9% of the ex-preterm were abnormal as per HNNE evaluation at term-corrected age. At short-term follow-up screening, 13.8% were found to be abnormal based on AT angles, while 35.2% were found to be abnormal as per CDC grading and 30.4% were found to have risk for delay as per DDST-II (gross motor). A high level of sensitivity (93.6%) and positive predictive value (91.2%) was observed for HNNE at term equivalent with MRI brain assessment considered as gold standard. Among the follow-up screening tools, CDC grading for sitting, AT angles, and DDST-II had high sensitivity (>85%).
Conclusion:
The combination of HNNE along with radiological assessment at term-corrected age can be considered as appropriate for predicting long-term neurodevelopmental outcome in VLBW pre-term infants. During follow-up, simple tools like CDC grading for motor milestones, AT angles, and DDST-II may be utilized if facilities for standard assessment are not available as in resource-poor settings.
