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The optimality concept and its clinical value
1University Paediatric Hospital, Department of Developmental Neurology, Ljubljana, Slovenia.
Insights
The perinatal optimality score effectively predicts later outcomes, especially when combined with clinical risk assessment at birth. This combined approach best identifies newborns needing specialized care, improving prognostic accuracy for conditions like cerebral palsy.
Area of Science:
- Neonatal care
- Perinatal medicine
- Developmental pediatrics
Background:
- The optimality concept assesses newborn condition at birth using a standardized checklist.
- Previous studies suggest optimality scores may have prognostic value for later developmental outcomes.
- A comprehensive screening of newborns in Slovenia was conducted to validate these concepts.
Purpose of the Study:
- To verify the clinical utility of the perinatal optimality concept.
- To assess the prognostic value of optimality scores for predicting later outcomes.
- To identify newborns at risk for adverse developmental outcomes.
Main Methods:
- Screening of 124,759 newborns across 14 Slovenian maternity hospitals (1987-1991).
- Adaptation of Prechtl's 51-item optimality list, focusing on obstetric variables.
- Analysis of optimality scores in relation to birth status, sex, and later development of conditions like cerebral palsy.
Main Results:
- Median optimality scores were 45 for mature and 41 for premature infants.
- Oxygen supply disturbances were the most common non-optimal factors.
- Lower optimality scores at birth were associated with cerebral palsy, with a more pronounced sex difference favoring girls.
- Specific patterns emerged for different types of cerebral palsy (diplegia, tetraparesis, dyskinesia) based on birth status and optimality scores.
Conclusions:
- The perinatal optimality score is a clinically useful tool for assessing newborn condition.
- Combining optimality scores with clinical risk assessment at birth significantly improves the accuracy of predicting disability.
- This combined approach is crucial for identifying high-risk newborns requiring targeted interventions and specialized attention.
Abstract:
To verify the clinical usefulness of the optimality concept in general and its prognostic value for later outcome, all babies born at all 14 maternity hospitals in Slovenia in the period from 1987 to 1991 (124,759 newborns) have been screened. In order to get an estimate of their condition Prechtl's original list of optimality has been adapted to 51 items representing mostly obstetric variables. The median of perinatal optimality scores for all newborns was 45 (six negative points) in mature, and 41 (10 negative points) in premature infants. Girls born at term scored better than mature boys, whereas there was no sex difference in the median score in prematures. Analysis of the data has shown that the majority of items which were non-optimal and which were associated with the greatest number of other non-optimal factors had to do with disturbances in oxygen supply. Children who developed cerebral palsy had a lower optimality score at birth than the remainder of the newborns. In these children the difference between the sexes is even more pronounced, to the advantage of the girls. Prematurely born children with spastic diplegia had a lower optimality score than mature children with diplegia. The opposite was noticed in children born prematurely and at term who developed spastic tetraparesis or dyskinesia. The present follow-up study has shown that predictions of disability were most accurate in the group of newborns who were clinically at risk at birth and who also had a low optimality score. The combination of both appraisals is the best way to identify newborns who need special attention.
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