Early assessment and neurodevelopmental outcome in very low-birth-weight infants: implications for pediatric practice.
To determine which assessments are useful, at what age, in order to identify handicaps in very low-birth-weight infants, neonatal cerebral ultrasound findings, neurological examinations and the mental scale of the Bayley Infant Scales of Development at 1 and 2 years of age were examined in relation to neurodevelopmental outcome at 3.6 years of age in a cohort of 79 high-risk very low-birth-weight infants. At 3.6 years of age, a minor handicap was found in 9 (11%) and a major handicap in 4 (5%) children. Cerebral palsy was found in 9 (11%) children at 3.6 years of age and could only be diagnosed reliably at 2 years of age. For short-term follow-up, as feedback to the neonatologist, the positive predictive value of intraparenchymal damage, as detected by neonatal cerebral ultrasound, was greater than the positive predictive value of a definitely abnormal neurological examination at 1 year of age. Visual handicaps (n = 4, 5%) and severe hearing deficits (n = 1, 1%) were all detected in the first year of life. A mental handicap was found in 7 (9%) children. It was impossible to predict mental handicaps for the individual child. Only 35% of the children with a mental delay at 2 years of age had a mental handicap at 3.6 years of age, whereas 35% had a normal cognitive outcome. Pediatricians therefore should be cautious in the interpretation of developmental test results in infancy. Long-term follow-up is essential for the child and its parents.
Weisglas-Kuperus
N
N
Department of Pediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands.
Baerts
W
W
Sauer
P J
PJ
D002547:Cerebral Palsy / Q000175:diagnosis / Q000000981:diagnostic imaging; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004453:Echoencephalography; D005260:Female; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000175:diagnosis; D007361:Intelligence Tests; D008137:Longitudinal Studies; D008297:Male; D009460:Neurologic Examination