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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental screening of in utero growth-retarded prematurely born children before school age
R Matilainen1, K Heinonen, H Siren-Tiusanen
1Children's Hospital, Kuopio, Finland.
Insights
Intrauterine growth restriction (IUGR) in premature infants is linked to significant neurodevelopmental issues by age 4. These effects, particularly in boys needing respiratory support, impact motor and perceptual functions.
Area of Science:
- Pediatrics
- Neurodevelopmental Science
- Perinatal Medicine
Background:
- Premature birth (gestational age ≤ 36 weeks) poses risks for long-term health.
- Intrauterine growth restriction (IUGR) is a significant concern in premature infants.
- Longitudinal studies are crucial for understanding developmental trajectories in this population.
Purpose of the Study:
- To evaluate the impact of IUGR on neurological and psychological development in premature children at age 4.
- To compare neurodevelopmental outcomes between preterm infants with and without IUGR.
- To identify perinatal factors associated with adverse neurodevelopmental outcomes.
Main Methods:
- Prospective follow-up of premature cohorts born 1976-1977.
- Neurological and psychological assessments at age 4 in 71 preterm children (48 AGA, 23 IUGR) and 36 full-term controls.
- Utilized a validated Neurodevelopmental Screening (NDS) test and four psychological tests.
Main Results:
- Significantly higher rates of moderate to high NDS risk scores in the preterm IUGR group compared to the preterm AGA group.
- Preterm IUGR children exhibited complex deviations in motor, visual, and perceptual functions.
- Preterm AGA children showed only minor NDS score elevations in fine motor and perceptual functions compared to controls.
Conclusions:
- IUGR is a primary risk factor for abnormal neurodevelopmental outcomes in preterm children by school age.
- Boys with IUGR requiring respirator therapy showed particular vulnerability.
- Early identification and intervention for IUGR-related neurodevelopmental deficits are essential.
Abstract:
As part of a prospective follow-up study of two premature cohorts (gestational age less than or equal to 36 weeks) born between 1976 and 1977, designed to evaluate the effects of IUGR on morbidity, mortality and neurological development in prematurely born children, 71 prematurely born children (48 AGA, 23 IUGR) without major neurological handicaps were subjected to detailed assessment of their neurological and psychological status at the age of 4 years. Thirty-six healthy full-term children formed a control group. The socioeconomic status of the families of the premature groups was similar to that of the families of the control group. The assessment consisted of a neurodevelopmental screening test and four psychological tests. Validation of the NDS test in relation to proven cognitive problems (sensitivity 96%, specificity 64%, relative risk 16.74) and determination of normal ranges were based on findings in the control group. There were significantly more children with moderate to high risk scores (greater than or equal to 10) among the IUGR group than among the AGA group. The neurodevelopmental profile of the preterm IUGR group was characterized by complex deviations of motor, visual and perceptual functions from normal. Preterm AGA children had only slightly higher risk scores in relation to fine motor, upper motor and perceptive functions than control children. Of the various perinatal factors studied, IUGR (especially in relation to boys who needed respirator therapy) was the most likely to be associated with abnormal NDS scores before school age.
