Approaches to neurodevelopmental assessment in congenital diaphragmatic hernia survivors.
BACKGROUND
Infants with congenital diaphragmatic hernia require complex surgical care and may have neurodevelopmental morbidity. We examined the performance of reports of motor functioning in 25 congenital diaphragmatic hernia survivors using the parent-completed Developmental Profile-II and a clinical evaluation by a neurodevelopmental pediatrician (MD) measured against the Bayley motor scale.


METHODS
Bayley motor scores were dichotomized as normal or abnormal. Sensitivity and specificity were calculated for each test.


RESULTS
The median age at assessment was 25 months. Bayley motor scores were abnormal in 77% of infants tested (10/13). The MD examinations detected motor problems in 92% (12/13). Sensitivity and specificity of the MD examination were 1.0 and 0.33, respectively. Developmental Profile-II physical scores were abnormal in 15% (2/13); sensitivity and specificity were 0.2 and 1.0, respectively.


CONCLUSIONS
The high rate of abnormal motor findings in this study supports the need for ongoing screening and evaluation. The sensitivity of MD examinations was excellent, but hypotonia findings were not universally corroborated by the Bayley. Although specificity of parent-reported motor findings was high, parents underreported abnormal motor findings. Parental reports of neurodevelopmental problems should be heeded, and physicians should perform screening motor examinations. Bayley assessments may be warranted to determine the functional implications of observed abnormalities.
Chen
Catherine
C
Department of Surgery, Children's Hospital, Boston, MA 02115, USA. catherine.chen@childrens.harvard.edu
Friedman
Sandra
S
Butler
Samantha
S
Jeruss
Stefanie
S
Terrin
Norma
N
Tighiouart
Hocine
H
Ware
Janice
J
Wilson
Jay M
JM
Parsons
Susan K
SK
D000015:Abnormalities, Multiple / Q000523:psychology / Q000601:surgery; D000328:Adult; D001925:Brain Damage, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D002658:Developmental Disabilities / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D006331:Heart Diseases / Q000453:epidemiology; D006548:Hernia, Diaphragmatic / Q000523:psychology / Q000601:surgery; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D008297:Male; D019957:Motor Skills Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D009123:Muscle Hypotonia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010290:Parents / Q000523:psychology; D010865:Pilot Projects; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011596:Psychomotor Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012120:Respiration Disorders / Q000453:epidemiology; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D017741:Survivors / Q000523:psychology*