Can Neurobehavioral Examination Predict the Presence of Cerebral Injury in the Very Low Birth Weight Infant?

Abstract

This study examined in a regional cohort of 66 term age very low birth weight infants, the relationship between qualitative magnetic resonance imaging (MRI) measures of cerebral white and gray matter abnormalities and infant neurobehavioral functioning assessed by structured neurological examination. The diagnostic utility of the Dubowitz neonatal neurological examination in identifying children with severe cerebral abnormalities was also evaluated. Examination results revealed the presence of high rates of neurological abnormality, with 60% of infants scoring in the suboptimal range relative to infants born full term. Linear associations were found between the severity of structural cerebral abnormality on MRI and the quality of clinically rated infant neurobehavioral functioning, with increasing abnormalities being significantly associated with poorer neurological functioning. In particular, white matter abnormalities were significantly associated with lower mean tone and tone pattern scores and a tendency toward lower mean reflex scores. Gray matter abnormalities were significantly associated with lower tone and tone pattern scores and a tendency toward lower spontaneous movements and orientation/behavior scores. Finally, the Dubowitz Neonatal Neurological Examination was found to have relatively good sensitivity (88%; negative predictive value, 92%) but poor specificity (46%; positive predictive value, 34%) for identifying children with significant MRI abnormalities. Implications of these findings for the neurological evaluation of the very low birth weight infant are discussed.

How to use: the neonatal neurological examination

“…Similar results were found in a cohort study of 66 very low birthweight infants who also had MRI 16. These infants had a mean gestational age of 28 weeks at birth, and all had neurological examination and MRI at term equivalent age.…”

Neurobehavioral Assessment Predicts Differential Outcome Between VLBW and ELBW Preterm Infants

“…However, the discerning qualities of the NAPI suggest there is evidence to moderate the current thinking. Another recent study shows good relationship between neonatal exam and brain MRI, 25 and in an earlier study, we found a neonatal neuro exam at term age to be predictive of CP in high-risk preterm infants. 26 A cautionary note must be made to the effect that in general the more robust infants failed to return for assessment at 30 months.…”

Early Brain Injury in Premature Newborns Detected with Magnetic Resonance Imaging is Associated with Adverse Early Neurodevelopmental Outcome

“…24 Consistent with findings in other cohorts, the neuromotor scores at the time of the MRI were higher in those newborns with moderate to severe MRI abnormalities. 25 It is unknown whether the application of a more sophisticated scoring system of the preterm neonatal neurologic examination, such as the Dubowitz scale, 24 might improve the predictive value of the early exam.…”