Development and evaluation of a follow up assessment of preterm infants at 5 years of age
article
Background: Long term follow up shows a high frequency of developmental disturbances in preterm survivors of neonatal intensive care formerly considered non-disabled. Aims: To develop and validate an assessment tool that can help paediatricians to identify before 6 years of age which survivors have developmental disturbances that may interfere with normal education and normal life. Methods: A total of 431 very premature infants, mean gestational age 30.2 weeks, mean birth weight 1276 g, were studied at age 5 years. Children with severe handicaps were excluded. The percentage of children with a correctly identified developmental disturbance in the domains cognition, speech and language development, neuromotor development, and behaviour were determined. Results: The follow up instrument classified 67% as optimal and 33% as at risk or abnormal. Of the children classified as at risk or abnormal, 60% had not been identified at earlier follow up assessments. The combined set of standardised tests identified a further 30% with mild motor, cognitive, or behavioural disturbances. The paediatrician's assessment had a specificity of 88% (95% CI 83-93%), a sensitivity of 48% (95% CI 42-58%), a positive predictive value of 85% (95% CI 78-91%), and a negative predictive value of 55% (95% CI 49-61%). Conclusions: Even after standardised and thorough assessment, paediatricians may overlook impairments for cognitive, motor, and behavioural development. Long term follow up studies that do not include detailed standardised tests for multiple domains, especially fine motor domain, may underestimate developmental problems.
Topics
Birth weightChildCognitive defectCognitive developmentControlled studyDevelopmental coordination disorderDevelopmental disorderDiagnostic accuracyDisease classificationDisease severityEvaluationFemaleFollow upGestational ageLanguage developmentMajor clinical studyMaleMedical assessmentNewborn intensive carePediatricianPrematurityPsychomotor developmentRisk assessmentSpeech developmentSurvival timeChild, PreschoolDevelopmental DisabilitiesFollow-Up StudiesHealth Status IndicatorsHumansInfant, NewbornInfant, PrematureInfant, Very Low Birth WeightPredictive Value of TestsPrognosisPsychometricsQuestionnairesReproducibility of ResultsRisk FactorsSensitivity and Specificity
TNO Identifier
237289
ISSN
00039888
Source
Archives of Disease in Childhood, 88(10), pp. 870-875.
Pages
870-875
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