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Updated: Aug 24, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Early predictors of neurodevelopmental outcome in high risk infants
K Godbole1, S Barve, S Chaudhari
1Department of Pediatrics, K.E.M. Hospital, Rasta Peth, Pune.
Insights
Simple developmental assessments at three and six months can predict one-year neurodevelopmental outcomes in high-risk infants. Key indicators include social smile, neurobehavior, and motor skills for early intervention.
Area of Science:
- Pediatrics
- Developmental Neuroscience
- Neonatology
Background:
- Early identification of neurodevelopmental delays in high-risk infants is crucial for timely intervention.
- Predictive markers for neurodevelopmental outcomes are needed for efficient screening.
Purpose of the Study:
- To identify simple, easily measurable developmental items at three and six months of age that predict neurodevelopmental outcomes at one year in high-risk infants.
Main Methods:
- A one-year longitudinal follow-up study of sixty high-risk infants discharged from the Neonatal Intensive Care Unit (NICU).
- Neurodevelopmental assessments at three and six months included social smile, primitive reflexes, neurobehavior, and motor milestones (e.g., pulling to sit, voluntary reach).
- Bayley Scales of Infant Development (Baroda Norms) were used for one-year outcome assessment.
Main Results:
- Absence of social smile and abnormal neurobehavior at three months predicted delayed outcomes.
- Absent pulling to sit, voluntary reach, and object transfer at six months also predicted one-year delays.
- These predictive items demonstrated 100% specificity and 100% positive predictive value.
Conclusions:
- Specific developmental milestones at three and six months are highly predictive of one-year neurodevelopmental status in high-risk infants.
- These easily elicited items, requiring no special equipment, can be utilized by healthcare providers at primary care levels.
- Early identification through these simple assessments facilitates timely intervention for improved infant neurodevelopmental outcomes.
Objective:
To find out a few simple and easily elicitable items at three and six months of age that can predict neurodevelopmental outcome at one year in high risk babies.
Design:
One year longitudinal follow up study.
Setting:
Hospital based study including inborn and outborn infants discharged from the Neonatal Intensive Care Unit (NICU) of a referral hospital, followed up in a High Risk Clinic.
Methods:
Sixty high risk babies were followed up longitudinally for a period of one year. A detailed neurodevelopmental examination was done with special attention to the following items-axillary suspension, head support, social smile, disappearance of primitive reflexes and neurobehavior at three months age while pull to sit, rolling over, sitting momentarily without support, transfer of objects and voluntary reach were evaluated at six months age. Bayley Scales of Infant Development (Baroda Norms) was used for assessing the outcome at one year.
Results:
Babies with absence of social smile, abnormal neurobehavior at three months and absent pulling to sit position, absent voluntary reach, and absent transfer of objects, remained delayed at one year. The specificity of each of these items was 100%. These items had a positive predictive value of 100%.
Conclusions:
Inability to achieve social smile and abnormal neurobehavior at three months age and absence of pulling to sit position, transfer of objects and voluntary reach at six months age, warrant early intervention. These items are easy to elicit, do not require any special kit or elaborate training. Hence these items can be tested even by those working at the primary level or in office practice.
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