title: An evidence-based approach to predicting low IQ in very preterm infants from the neurological examination: outcome data from the indomethacin Indomethacin Intraventricular Hemorrhage Prevention Trial.
abstract: We evaluated whether the degree of cerebral palsy (CP) at age 3 in very preterm children is predictive of full-scale intelligence quotient (FSIQ) <70 at age 8 by calculating likelihood ratios (LRs) for findings on the neurologic examination. Data from the follow-up phase of the Indomethacin Intraventricular Hemorrhage Prevention Trial, which includes periodic neurologic examination and neuropsychometric testing, were used. Information was available on 366 of 440 (83%) children with birth weight of 600 to 1250 g who survived. Neurologic examination at age 3 was grouped by presence and type of CP, and the Weschler Intelligence Scale for Children-Third Edition FSIQ at age 8 was grouped dichotomously (<70 or > or =70). CP was identified in 35 of 366 3-year-olds (9.5%). An FSIQ <70 was identified in 47 of 366 children at 8 years old (12.8%). FSIQ <70 occurred in 14 of 17 children with tri- or quadriplegia (82%), 8 of 18 children with di- or hemiplegia (44%), and 25 of 331 children without CP (7.5%). Useful LRs were calculated for tri- or quadriplegia (30), di- or hemiplegia (5.7), and children without CP (0.55). These LRs have greater impact on posttest odds for FSIQ <70 than those for birth weight <1000 g, history of bronchopulmonary dysplasia, and Stanford-Binet Intelligence Score <70 at age 3. We conclude that the neurologic examination at 3 years old predicts FSIQ <70 at age 8 with LRs that allow evidence-based parental counseling and intervention planning.
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, Maine Medical Center, Portland, Maine, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Pleacher
authors.forename: Betty R
authors.initials: BR
authors.lastname: Vohr
authors.forename: Karol H
authors.initials: KH
authors.lastname: Katz
authors.forename: Laura R
authors.initials: LR
authors.lastname: Ment
authors.forename: Walter C
authors.initials: WC
authors.lastname: Allan
mesh_terms: D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008607:Intellectual Disability / Q000150:complications / Q000175:diagnosis*; D007361:Intelligence Tests; D016013:Likelihood Functions; D009460:Neurologic Examination; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity