Assessment of neurological status in preterm infants in neonatal intensive care and prediction of cerebral palsy

Abstract

The purpose of this study was to determine the diagnostic accuracy of a neurological assessment performed before discharge from the nursery to predict cerebral palsy at three years of age in preterm infants. Infants born < 31 weeks gestation between 1992 and 1996 were assessed using the Lacey Assessment of the Preterm Infant (LAPI) prior to discharge. Infants were classified as having no abnormality, possible abnormality, or definite abnormality. At three years of age, the infants had a neurological examination. Infants were stratified into those assessed at < or = 33 weeks postmenstrual age and those assessed at least once > 33 weeks postmenstrual age. Of the 203 infants, 36 were diagnosed with cerebral palsy at three years. Seven were assessed < or = 33 postmenstrual age and 29 were assessed > 33 weeks postmenstrual age. For infants assessed < or = 33 weeks and classified as having any abnormality (possible or definite), the LAPI had 86% sensitivity, 83% specificity, and 96% negative predictive value for subsequent cerebral palsy. The LAPI was less accurate when applied to infants < 33 weeks postmenstrual age. The LAPI is an accurate diagnostic tool in the preterm period for the prediction of normal motor development or cerebral palsy at three years of age. This information may be used to target intervention.

A systematic review of tests to predict cerebral palsy in young children

“…Two studies evaluated the accuracy of CUS within the first days of life (before day 2 and before day 7), during which time 84% and 99% respectively, of cases of IVH will occur . Sensitivity (43–44%) and specificity (82–87%) were similar in these two studies (Table SII).…”

“…Ten studies, with a total of 2644 patients, met the criteria for evaluation of CUS (Table SII and Appendix SII) . There was variability in the specific focus of this investigation and in the definition of normal or low‐risk versus high‐risk infants.…”

“…Central nervous system (CNS) malformation was excluded from analysis in three studies with reported predictive specificity of 82 to 90% . Although the negative predictive value from these studies (88–89%) was less than when CNS malformation was included (88–89% vs 97.6%), the likelihood ratios did not differ between studies regardless of inclusion or exclusion of CNS malformation …”

“…There are many investigatory modalities that may assist in early accurate diagnosis of CP, including early motor assessment tools, brain imaging (cranial ultrasound [CUS] and magnetic resonance imaging [MRI]) and neurological examination (more commonly the standardized Lacey Assessment of Preterm Infants and the Hammersmith Infant Neurologic Examination) …”

Quantitative analysis of cranial ultrasonographic periventricular echogenicity in relation to early neuromotor development in preterm infants

“…A certified physical therapist who was blinded to the infants’ CUS variables administrated the Lacey Assessment of the Preterm Infant (LAPI) to each study participant prior to discharge29 after reaching the 35th week of gestation. The assessment included motor (eight items), oral (two items) and tone scores (four items), which constituted the total developmental score, and a neurological score (eight items of atypical neuromotor responses).…”