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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Development of a new scoring method in the neurofunctional assessment of preterm infants
Odoardo Picciolini1, Maria Lorella Giannì2,3, Laura Messina1
1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Physical Medicine & Rehabilitation Unit, Milan, Italy.
Insights
Neurofunctional Assessment (NFA) domains at 3 months corrected age predict neurodevelopmental outcomes in preterm infants at 2 years. A higher NFA complexity score (CS) indicates increased risk for later developmental delay.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Neurodevelopmental assessment
Background:
- Preterm infants face significant risks for neurodevelopmental delays.
- Early identification of neurodevelopmental issues is crucial for timely intervention.
- The Neurofunctional Assessment (NFA) evaluates infant neurodevelopment across six domains.
Purpose of the Study:
- To assess the association between NFA domains at 3 months corrected age (CA) and neurodevelopment at 2 years CA in preterm infants.
- To introduce and validate the NFA complexity score (CS) for identifying infants at high risk of neurodevelopmental delay.
- To establish a predictive threshold using the NFA CS.
Main Methods:
- Observational, longitudinal study of 211 preterm infants.
- Neurofunctional Assessment (NFA) administered at 3 months CA.
- Griffiths Mental Developmental Scales Extended Revised (GMDS-ER) used for neurodevelopmental evaluation at 2 years CA.
- Statistical analysis including linear models to assess relationships.
Main Results:
- Normal NFA domain scores at 3 months CA were significantly associated with higher GMDS-ER global quotient (GQ) at 2 years CA.
- A significant negative relationship was found between NFA CS and 2-year GMDS-ER GQ (estimate: -0.27, p < 0.001).
- Each 10-point increase in NFA CS correlated with an average 2.7-point decrease in GMDS-ER GQ.
Conclusions:
- NFA domains assessed at 3 months CA are valuable predictors of neurodevelopmental outcomes at 2 years CA in preterm infants.
- The NFA complexity score (CS) serves as a robust tool for early identification of preterm infants at risk for neurodevelopmental delay.
- These findings underscore the utility of NFA and NFA CS in clinical practice for early risk stratification and intervention planning.
Abstract:
Infants born preterm are at high risk of presenting neurodevelopmental delay. The Neurofunctional Assessment (NFA) describes infants' neurodevelopment through the evaluation of six different domains. This study aimed to evaluate how, in a cohort of preterm infants, each NFA domain assessed at 3 months of corrected age (CA) was associated with neurodevelopment at 2 years of CA using the Griffiths Mental Developmental Scales Extended Revised (GMDS-ER). In addition, by introducing the NFA complexity score (CS), the study aimed to define a threshold that can help clinicians discriminate infants at higher risk of later neurodevelopmental delay. We conducted an observational, longitudinal study including 211 preterm infants. At 3 months of CA, infants who had normal scores in each domain showed a significantly higher GMDS-ER global quotient (GQ) at 2 years of CA. In addition, linear model results showed a significant negative relationship between the NFA CS and 2-year GMDS-ER GQ (estimate: - 0.27; 95% CI - 0.35, - 0.20; p value < 0.001). Each 10-point increase in the NFA CS was associated with an average 2.7-point decrease in the GMDS GQ. These results highlight how the NFA domains and NFA CS are compelling instruments for the early identification of children at risk for long-term adverse outcomes.
