Original Articles
Predictive value of neonatal neurological tests for developmental outcome of preterm infants,☆☆,

https://doi.org/10.1067/mpd.2000.106901Get rights and content

Abstract

Background: There is a need to identify, as early as possible, infants who are at risk for long-term neurological morbidity. Methods: To predict neurodevelopment outcome of preterm infants <30 weeks’ gestation in a population of 100 infants, we used several neonatal and neurobehavioral tests, including cranial ultrasonography, the Prechtl neurological test, quality of spontaneous general movements, and quality of sleep-wake organization. Results: The Prechtl test at corrected term age and findings on cranial sonograms both had high specificity, but the Prechtl test had better overall positive predictive power for normal neurological and developmental outcomes at 2 years’ corrected age. Developmental changes in sleep and the amount of indeterminate sleep did not correlate with outcome. Scoring general movement quality did not predict outcome and did not augment the positive predictive power of the Prechtl test. Conclusions: The Prechtl test at corrected term age (independent of the other tests) is the best positive predictor of normal neurological outcome and Bayley test results at 2 years’ corrected age. (J Pediatr 2000;137:100-6)

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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    Supported by Nutricia, The Netherlands.

    ☆☆

    This report is part of a study in fulfillment of the Degree in Philosophy in Science for Y. G. H. Maas.

    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.

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