title: Prognostic neurodevelopmental testing of preterm infants: do we need to change the paradigm?
abstract: Longitudinal follow-up with assessment of developmental status at about 2 years of age is routine for high-risk newborns. The results of these assessments can be used for many purposes, including helping physicians, parents, and teachers plan educational or developmental interventions. These assessments also provide outcome measures for clinical research studies. Outcome results may also serve as a source of information for clinicians when counseling parents regarding provision of care for extreme preterm infants. Consideration should be given to use of different outcome metrics based on the purpose for testing. Categorization of composite cognitive, motor and neurosensory findings to define levels of impairment should be limited to research. Planning for individual interventions is better guided by descriptive findings. Current tools for assessing neurodevelopmental status at 2 years of age have important limitations. First, outcomes at early ages do not always predict function later in life. They are, at best, an estimate of longer-term outcomes, with important individual variation. For infants without severe neurologic injury, postnatal environmental factors play a predominant role in determining long-term cognitive and academic outcomes. Further investigations should assess quality of life and other considerations that are important for parents when making decisions about neonatal intensive care unit care for their infant.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
authors.forename: H W
authors.initials: HW
authors.lastname: Kilbride
authors.affiliation: Division of Developmental and Behavioral Pediatrics/Psychology, Southern Illinois University School of Medicine, Springfield, IL, USA.
authors.forename: G P
authors.initials: GP
authors.lastname: Aylward
authors.affiliation: Research Office, Royal Women's Hospital, Department of Obstetrics & Gynaecology, University of Melbourne, Clinical Sciences, Murdoch Children's Research Institute, Parkville, VIC, Australia.
authors.forename: L W
authors.initials: LW
authors.lastname: Doyle
authors.affiliation: School of Medicine, Department of Epidemiology and Statistics, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: L T
authors.initials: LT
authors.lastname: Singer
authors.affiliation: Children's Mercy Bioethics Center, Children's Mercy-Kansas City and the University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lantos
mesh_terms: D002490:Central Nervous System / Q000254:growth & development*; D002657:Child Development; D003071:Cognition; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight / Q000254:growth & development*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D009043:Motor Activity; D009483:Neuropsychological Tests / Q000592:standards*; D011379:Prognosis; D011788:Quality of Life