Original ArticlesPredictive value of neonatal neurological tests for developmental outcome of preterm infants☆,☆☆,★
Section snippets
Subjects
The infants were a subset of infants from a double-blind prospective controlled trial on the effects of thyroxine supplementation on neurological development.15 The study was approved by the Medical Ethical Committee of the Academic Medical Center, Amsterdam. Infants born at a gestational age of <30 weeks and admitted to the intensive care unit of the Academic Medical Center, Amsterdam, were enrolled if informed consent was obtained. Gestational age was determined by the maternal menstrual
Results
At 2 years’ CA, the Touwen/Hempel neurological examination classified 75 infants as normal, 16 as suspect, and 9 as abnormal. According to the Bayley scales for the MDI, 74 infants were classified as normal (≥84), 14 as suspect (83-68), and 9 as abnormal (<68); for the NVDI 80, 8, and 12, respectively; for the PDI 55, 29, and 14, respectively. The results of the 2 tests show differences that may be due in part to the fact that the Touwen/Hempel test evaluates neurological function, whereas the
Discussion
The main purpose of this study was to investigate the value of cranial ultrasonography results from the early neonatal period and several neurobehavioral tests at term CA as predictors of neurological and developmental outcome at 2 years’ CA. The Prechtl score at term CA was the only test (independent of the other tests) that could predict neurological and developmental outcome at 2 years’ CA; 84% of all infants who scored normal for the Prechtl test at term were also normal for the
Acknowledgements
We thank all participating infants and their parents for their cooperation. We are grateful to all medical and nursing staff of our neonatal department for their contributions to the study, to Dr A. G. van Wassenaer and H. Smolders-De Haas for the Prechtl tests, to Dr A. G. van Wassenaer and J. M. Briët for providing the data from all 2-year follow-up examinations; to Dr J. H. Kok, Dr B. J. Smit, and Dr P. Tamminga for scoring the cranial sonograms; to Dr M. Hadders-Algra for her contribution
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Cited by (43)
Combined predictors of neurodevelopment in very low birth weight preterm infants
2019, Early Human DevelopmentCitation Excerpt :Predictive values of tests performed in parallel might be statistically higher than predictive values of each test. Maas [37] compared predictive values of several tests alone and in combination with other tools (brain ultrasound, generalized movements test, sleep organization test) in 100 babies with gestational age <30 weeks. They found that Prechtl neurological test at term corrected age had the highest predictive value, comparable to that of cranial US, but they could not find an additive effect on prediction power of either test.
Neurological Examination
2018, Volpe's Neurology of the NewbornEvaluation of somatosensory cortical processing in extremely preterm infants at term with MEG and EEG
2015, Clinical NeurophysiologyCitation Excerpt :Extremely preterm birth is associated with a variety of adverse neurodevelopmental sequelae including cerebral palsy and milder neuromotor abnormalities, as well as cognitive and behavioral problems (Marlow et al., 2005; Mikkola et al., 2005; Aarnoudse-Moens et al., 2009). Neonatal neurological assessment methods are widely used to identify the infants at higher risk for neurodevelopmental adversities, but are unable to recognize all infants with adverse outcome (Majnemer and Rosenblatt, 1995; Maas et al., 2000) and therefore other predictors have been searched from neuroimaging and neurophysiology. The neurodevelopmental impairments in preterm infants are suggested to result from a complex combination of primary parenchymal lesions (i.e., ischemic/hemorrhagic insults) and secondary maturational and trophic disturbances (Volpe, 2009a,b; Kinney and Volpe, 2012).
Trajectories of general movements from birth to term-equivalent age in infants born <30weeks' gestation
2015, Early Human DevelopmentCitation Excerpt :In a study of 21 preterm infants, Bos et al. [37] found a significant association between the duration of periventricular echodensities in the parieto-occipital white matter, but not in the frontal area, and individual GMs trajectories, suggesting that the duration and location of echodensities had an impact on GMs quality. Furthermore, other studies have reported the concurrent validity of GMs and cranial ultrasound findings, with a combination of the two assessments increasing the accuracy of predicting neurodevelopmental outcome in preterm infants [7,15,38,39]. Cramped synchronised GMs have been shown to be a predictor for cerebral palsy [40], particularly when observed over multiple assessments, and when present close to TEA [18].
Prognostic value of the qualitative assessments of general movements in late-preterm infants
2013, Early Human DevelopmentCitation Excerpt :A recent review on neuromotor assessments for preterm infants has put further stress on the fact that no single GM assessment has yet reliably identified normal or atypical motor development in a given group of infants [15,27]. Some studies described GM trajectories encompassing both the writhing and fidgety period in preterm [17,27,28] and full-term infants [29]. These reported that infants with consistently normal GMs had normal outcomes, whereas those with transient abnormal trajectories could either present a normal or an abnormal outcome.
Early neurologic assessment in preterm-infants: Integration of traditional neurologic examination and observation of general movements
2008, European Journal of Paediatric NeurologyCitation Excerpt :As the availability of such an organised multimodal follow-up program is often hampered by limited resources, neurologic examination necessarily plays a foremost role among the clinical tools, for its low-cost and high transferability. Most of the studies assessing early neurologic function in preterm infants have either dealt with small groups of mainly high-risk newborns, or have used qualitative and non-standardised measures of neurologic development.5–10 An overall good prognostic value of the different types of traditional neurologic assessment has been usually shown in these studies, however the number of false responses limits the application of infant traditional neuroexam as a tool for outcome prediction, especially when used in large follow-up and screening projects. 11,12
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Supported by Nutricia, The Netherlands.
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This report is part of a study in fulfillment of the Degree in Philosophy in Science for Y. G. H. Maas.
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Reprint requests: Yolanda G. H. Maas, MSc, Visual System Analysis Department, Academical Medical Center, University of Amsterdam, PO Box 12011, 1100 AA, Amsterdam, The Netherlands.