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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The Establishment of a Simplified Clinical Scoring System for Neurodevelopmental Follow-Up and Its Application in
Jicheng Li1,2, Xing Zhu1,2, Mingrui Shi1,2
1Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing, China.
Background:
Neurodevelopmental impairment (NDI) remains a major adverse neurodevelopmental outcome in very preterm infants. Given variations in follow-up practices across centres, there is a need for a simplified clinical tool to quantify the cumulative burden of neonatal morbidities and facilitate early risk stratification. This study aimed to establish and validate a simplified scoring system for predicting NDI at 24-month corrected age in very preterm infants, providing an accessible framework for optimized follow-up management.
Methods:
Data were obtained from a standardized neonatal follow-up database for infants born at gestational age (GA) < 32 weeks between May 2022 and December 2023. Neurodevelopment was assessed using a standardized developmental instrument validated for the Chinese population. Independent predictors of NDI at 24 months were identified using multivariable logistic regression. A nomogram was constructed, from which a simplified clinical scoring system was derived to support risk-stratified follow-up management.
Results:
Of 306 eligible infants, 264 (86.3%) completed the 24-month follow-up, among whom 67 (25.4%) developed NDI. Multivariable analysis identified GA, male sex and cumulative morbidity count as independent predictors. The predictive nomogram demonstrated strong discrimination with an area under the receiver operating characteristic curve of 0.877 (95% CI: 0.832-0.921). A simplified scoring system was derived from the regression coefficients using a weight transformation method. Based on the maximum Youden index, the optimal cut-off value was 7.0, identifying high-risk infants with 74.6% sensitivity, 82.2% specificity and a negative predictive value of 90.5%. Clinical risk stratification was significantly associated with actual intervention rates.
Conclusion:
The simplified scoring system, integrating cumulative morbidities, sex and GA, provides a practical and accessible tool for predicting 24-month NDI risk in very preterm infants. It may facilitate early risk identification, guide individualized follow-up planning and support integration of targeted surveillance and intervention strategies into routine neonatal follow-up programmes.
