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Predicting neurodevelopment in very preterm infants using the Test of Infant Motor Performance
April E Williamson1, Roslyn N Boyd2, Robert S Ware3
1School of Allied Health, Australian Catholic University, Brisbane, Australia.
Insights
The Test of Infant Motor Performance (TIMP) has limited accuracy in predicting neurodevelopmental impairments in very preterm infants (VPT). While it identifies most infants without issues, it misses some with later adverse outcomes.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Infant motor assessment
Background:
- Very preterm (VPT) infants face higher risks of neurodevelopmental impairments.
- The Test of Infant Motor Performance (TIMP) assesses gross motor skills, but its predictive value in VPT infants requires further investigation.
Purpose of the Study:
- To evaluate the accuracy of TIMP assessments at term equivalent age (TEA) and 3 months corrected age (CA) for identifying motor or cognitive impairments at 12 months CA in VPT infants.
Main Methods:
- A prospective observational cohort study included 202 infants born before 31 weeks gestational age.
- TIMP was administered at TEA and 3 months CA.
- Neurodevelopmental outcomes were assessed at 12 months CA using the Alberta Infant Motor Scale (AIMS), Neurological Sensory Motor Development Assessment (NSMDA), and Bayley Scale of Infant and Toddler Development 3rd edition (Bayley III).
Main Results:
- TIMP demonstrated higher specificity than sensitivity across all outcome measures.
- At TEA, TIMP z-scores (≤ -0.5) showed low sensitivity and specificity for motor outcomes (NSMDA, AIMS, Bayley III).
- Area under the curve analyses indicated that TIMP assessments at 3 months CA were more accurate than at TEA for predicting impairments at 12 months CA.
Conclusions:
- TIMP assessments at TEA and 3 months CA identified most VPT infants without motor and cognitive impairments.
- However, the TIMP failed to identify some VPT infants who later developed adverse neurodevelopmental outcomes by 12 months CA.
Background:
Infants born very preterm (VPT) are at increased risk of neurodevelopmental impairments. The Test of Infant Motor Performance (TIMP) is an assessment used to evaluate an infant's gross motor skills, however, understanding of its predictive accuracy in VPT infants is limited.
Aims:
To determine the accuracy of the TIMP assessed at term equivalent age (TEA), and 3 months corrected age (CA), to identify motor or cognitive impairment at 12 months CA in VPT infants.
Method:
This prospective observational cohort study recruited 202 infants born at <31wks gestational age (GA). At TEA and 3 months CA the TIMP was performed. At 12 months CA the following neurodevelopmental assessments were conducted; Alberta Infant Motor Scale (AIMS), Neurological Sensory Motor Development Assessment (NSMDA) and Bayley Scale of Infant and Toddler Development 3rd edition (Bayley III).
Results:
The TIMP had higher specificity than sensitivity across all four outcome measures. Using a cut off-of ≤ -0.5 at TEA, TIMP z-scores demonstrated low sensitivity and specificity for motor outcomes on the NSMDA (sensitivity 61 %, specificity 50 %), AIMS (sensitivity 59 %, specificity 50 %) and Bayley III (sensitivity 56 %, specificity 51 %). Area under the curve analyses showed that the TIMP assessed at 3 months had greater accuracy than at TEA in identifying neurodevelopmental impairments at 12 months CA.
Conclusions:
The TIMP assessed at TEA and 3 months CA correctly identified the majority of VPT infants without motor and cognitive impairments. However, it missed VPT infants who developed adverse neurodevelopmental outcomes by 12 months CA.
