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Do parents and professionals agree on the developmental status of high-risk infants?
M M Kim1, K S O'Connor, J McLean
1St Joseph's Health Centre, Department of Pediatrics, University of Western Ontario, London, Canada.
Insights
Parental reporting of infant development using the Infant Monitoring Questionnaire (IMQ) showed poor agreement with professional assessments for high-risk infants. The IMQ is not recommended as a substitute for clinical evaluation in the first year.
Area of Science:
- Neonatal Development
- Pediatric Assessment
- Clinical Evaluation
Background:
- High-risk infants discharged from neonatal intensive care units (NICUs) require ongoing developmental monitoring.
- Parental reporting is a potential source of information on infant development, but its accuracy compared to professional assessments needs evaluation.
Purpose of the Study:
- To examine the agreement between parental developmental assessments using the Infant Monitoring Questionnaire (IMQ) and professional evaluations by a multidisciplinary team for high-risk infants.
Main Methods:
- 196 infants from NICUs were assessed by parents using the IMQ and by a multidisciplinary team at 4, 8, or 12 months corrected age.
- The kappa statistic was used to measure agreement between parental and professional classifications (normal, suspect, abnormal).
- Logistic regression analyzed factors influencing agreement.
Main Results:
- Overall agreement between parental IMQ reporting and multidisciplinary team assessments was poor (kappa = 0.276).
- Despite similar proportions of infants in each category (normal, suspect, abnormal) by both methods, individual classifications showed low concordance.
- No infant or family characteristics were found to significantly influence the agreement level.
Conclusions:
- Parental developmental assessment using the IMQ shows poor agreement with multidisciplinary team evaluations in high-risk infants during the first year of life.
- The IMQ is not recommended as a replacement for clinical assessments in this population.
- The IMQ may serve as an adjunct to clinical assessment or be useful when no other data is available.
Objectives:
To examine the degree of agreement between parental reporting of the development of high-risk infants and professional assessment by a multidisciplinary team.
Methods:
The developmental status of 196 infants discharged from neonatal intensive care units (NICUs) was assessed by their parents using the Infant Monitoring Questionnaire (IMQ) at 4, 8, or 12 months' corrected age. On the same day, a clinical assessment was done by a multidisciplinary team consisting of a developmental pediatrician, physical therapist, and psychologist. The kappa statistic was used to measure agreement between the assessments. Logistic regression was used to investigate factors that might influence agreement.
Results:
Both the IMQ and the multidisciplinary team classified infants as developing normally ("normal"), being at risk for abnormal development ("suspect"), or developing abnormally ("abnormal"). Although the same proportion of children fell into the three categories by both assessments, parents and the multidisciplinary team showed poor agreement with respect to the classification of individual infants (kappa = 0.276). No infant or family characteristic was found to have an influence on agreement.
Conclusions:
For a group of high-risk infants discharged from NICUs, the agreement between parental assessment of developmental status using the IMQ and the professional assessment by a multidisciplinary team is poor in the first year of life. We do not recommend the use of this questionnaire as a substitute for clinical assessment of biologically at-risk infants discharged from NICUs. However, it may be useful for those groups of infants for whom no other information is available or as an adjunct to clinical assessment when infants are not behaving typically because of an unfamiliar setting or concurrent illness.