Assessment of preterm infants in the intensive‐care unit to predict cerebral palsy and motor outcome at 6 years

Abstract

One hundred and fifty-three infants were assessed by a method specitlc to preterm infants and appropriate to the intensive-care nursery environment. The presence or absence of six atypical features (coarse jitters. dominant asymmetrical tonic neck reflex, paucity of movement, 'contradictory' development, hypotonia, or hypertonia) resulted in neonatal classi5cation. There were 116 'usual' (an absence of atypical features with progressive development), 26 'unusual' (a transient occurrence of any atypical feature), and 11 'suspect' (dominance of one or more atypical features). At 6 years of age the motor subsystems of balance, cgordination, fine and gross motor, and associated movements were assessed. Nine of il children with cerebral palsy had neonatal categories of 'suspect' (7) and 'unusual' (2). of the remaining four other 'suswct' children, two failed two motor subsystems and two failed motor items. A 'usual' neonatal assessment predicted normal motor outcome for 7!2 of 116 (82%) whereas a 'suspect' assessment predicted major motor dysfunction for seven of 11 of the children. INeonatal intensive-care nurseries are witnessing a marked increase in the survival rate of infants born at very low gestational age and discharge before term-equivalent age. There is no published neurological assessment method specifically for these immature infants that is appropriate for thc intensivc-care nursery during the pretcnn period. Methods standardized for term infants, or both preterm and term infants, are still used for neurological assessment at term-equivalent agc, despite early studies that have highlighted the differences between the preterm and t e k infants: Kurtzbcrget al. This paper compares the neurological ;issessments at prcterm age with 6-year outcomes to evaluate two hypotheses: (1) preterm infants who demonstrate 'usual' development of posture and movement on the longitudinal assessment during the preterm period have normal motor outcome at 6 years; and (2) pretenn infants who repeatedly show one or more atypical features during the preterm assessment have abnormal motor outcomc at 6 years. Xethod S'I urn POPlrIA,lIONThe subjects of the study are prematurely born children who undenvent a longitudinal assessment at preterm age (see below) and whose parents consented to a Winded' followup study when the children were 6 years old. The infants were all nursed in the intensive-care nursery at King George V Hospital. Sydney, Australia between 1982 and 1984. Infants with a known gestational age of 5 34 w e c h and/or a binhweight of <2000g or < 10th centile weight for gestational age, and who were without congcnital anomalies were eligible for enrolment in this prospective study ( N = 3 0 3 ) .Subjects should have had three or more examinations in the neonatal period, but were excluded if 13 examinations were completed. Four study chil+n died: one with pulmonary atresia; one from a motor vehicle accident; and two from sudden infant death syndrome. The neonatal classifications o f the latter two were 'unusual' and 'sus...

Predictive validity of the Lacey Assessment of Preterm Infants for motor outcome at 2 years corrected age

“…GMDS-ER locomotor scores at 2 years were significantly higher for infants classified as usual than those classified as monitor ( p = 0.003), demonstrating significantly less motor delay (2.00 months versus 6.00 months; p = 0.001). These results support previous findings, in which infants within the ‘suspect’ LAPI group showed significantly lower scores than the ‘usual’ group on the Touwen motor assessment at 6 years of age, for all motor subsets including balance, co-ordination and fine-motor skills ( p < 0.05) [ 11 ]. Linear regression analysis found a predicted delay of 3.58 months for infants classified as monitor, after accounting for the effects of GA, BW, presence of NEC, CLD and genetic abnormalities.…”

“…Marcroft et al [ 10 ] similarly reported a high specificity of 89% (95% CI 71% to 98%), with wider CI due to the smaller sample size. Very high specificity of 98% was reported by Lacey and Henderson-Smart [ 11 ] and Lacey et al [ 9 ], when comparing with neuromotor outcomes at 3 and 6 years old, perhaps due to a more robust diagnosis of CP at this later age when transient abnormal motor signs present in the first few years have resolved.…”

“…However, a more recent pilot study by Marcroft et al [ 10 ] using the current version of the LAPI found an improved sensitivity of 75%. Specificity across studies is consistently high (83–98%), suggesting that the LAPI assessment could be used to identify infants at low risk of developmental difficulties to provide reassurance to families and help guide appropriate provision of early intervention resources [ [9] , [10] , [11] ].…”