Janet C. Constantinou

Prediction of the development of low birth weight preterm infants by a new neonatal medical index

A new neonatal medical index (NMI) was used to predict the mental and motor development of low birth weight, preterm infants up to 3-years-old. The NMI is a summary score of only a few clinically salient items that are readily available on brief chart review. The sample consisted of 512 of 608 infants randomly assigned to the control group of the eight-site Infant Health and Development Program and on whom the complete set of developmental outcome measures was available. The developmental tests administered were the Bayley Scales at 12 and 24 months and the Stanford-Binet at 3 years. The findings indicated the NMI was predictive of later cognitive and motor development, and in infants born weighing less than 1500 g, the effects of neonatal medical complications continued to adversely influence these childrens development to at least 3 years of age. In the heavier babies the developmental effects of sociodemographic factors predominated by 24 months and beyond.

Movement, imaging and neurobehavioral assessment as predictors of cerebral palsy in preterm infants.

Objective:To study the relative efficacy of three early predictors of cerebral palsy.Method:One Hundred and thirty infants with birth weight <1500 g were recruited. Video recordings of spontaneous general movements were made at 36 and 52 weeks postconceptional age. Magnetic resonance imaging and the neurobehavioral assessment of the preterm infant were done at 36 weeks postconceptional age. Follow-up neurological examination and Bayley assessments were made at 18 months corrected age to make early identification of cerebral palsy.Results:Magnetic resonance imaging gave the best specificity and accuracy of 91 and 84% respectively. General movements at 52 weeks showed an improved specificity and accuracy over performance at 36 weeks postconceptional age. The negative predictive value for all methods tested was between 90 and 97%. Combining the results of magnetic resonance imaging and the neurobehavioral assessment improved the sensitivity of prediction to 80%, suggesting that a holistic approach to early detection of cerebral lesions is preferable to a single test.Conclusions:The majority of infants who appeared to behave within normal limits and exhibit normal brain structure in the newborn period were classified as neurologically intact at follow-up.

Neurobehavioral assessment predicts differential outcome between VLBW and ELBW preterm infants

OBJECTIVE:To evaluate the impact of birth weight on development of very low birth weight (VLBW) infants using the Neurobehavioral Assessment of the Preterm Infant (NAPI) before hospital discharge, and to show the relation to follow-up outcomes at 12, 18 and 30 months of age.STUDY DESIGN:In total, 113 preterm infants were assessed with the NAPI at 36 weeks postmenstrual age. Later, neurodevelopment was examined using the Bayley Infant Neurodevelopmental Screener (BINS) at 12 months and the Bayley Scales of Infant Development, at 18 and 30 months. The cohort was divided into two groups, based on birth weight, extremely low birth weight (ELBW) (<1000 g) and VLBW (1000 to 1500 g).RESULTS:ELBW infants showed significantly lower NAPI scores compared with VLBW infants at 36 weeks. The predischarge NAPI scores correlated with the 12, 18 and 30 months scores when the ELBW infants continue to have lower performance than the VLBW infants. In all, 14 infants developed cerebral palsy. These infants had significantly lower NAPI, BINS and Bayley scores compared with all other preterm infants.CONCLUSION:NAPI before discharge provides clinically meaningful information related to later neurodevelopmental outcome.

Neonatal Severity of Illness Scorinng Systems: A Comparison

Several different scoring systems have been developed to predict neonatal morbidity and mortality. In this investigation we compared the utility of four severity of illness scoring systems (SISS) as predictors of days on ventilator (DOV), length of hospital stay (LOS), and mortality in very-low-birth weight (VLBW) premature infants who required mechanical ventilation. The SISS assessed were the Score for Neonatal Acute Physiology (SNAP); the Score for Neonatal Acute Physiology—Perinatal Extension (SNAP+PE); Clinical Risk Index for Babies (CRIB), and the Sinkin Score at 12 hours (SS12). Results revealed significant correlations among the SS12, SNAP, SNAP+PE, CRIB, birth weight (BW), DOV, and LOS. However, none of the systems we assessed offered striking advantage over BW in a VLBW ventilated group.

Stable Individual Differences in Developmentally Changing Preterm Infants: A Replicated Study.

In a longitudinal study with the Neurobehavioral Maturity Assessment (NB-MAP), developmental changes and stability of individual differences were assessed in 2 independent samples of preterm infants ranging from 32 weeks conceptional age to term. Individual stability of response was assessed using regression analysis with repeated measures on subjects. The large majority of the functions tested showed highly significant developmental gains with age and highly significant individual stability of performance across age. These findings replicated well across the 2 cohorts. The results are discussed in the light of the neurobiological stage of development of preterm infants during the last 8 weeks prior to term.

Effects of Skin-to-Skin Holding on General Movements of Preterm Infants

The study objective was to test the hypothesis that the effect of skin-to-skin (STS) holding increases the ratio of rest to activity in low birth weight preterm infants. Ten infants with birthweight <2,000 grams were videotaped before and after STS holding. Video recordings were analyzed to determine the number of general movements. We found no statistically significant difference between the percentage of general movements over the two periods. We conclude that the ratio of rest-activity before and after STS holding does not change as measured by occurrence of general movements.

Comparison at 32–37 Weeks Postconception of Infants Born 1983–1989 and 1995–2004 on the Neurobehavioral Assessment of the Preterm Infant

In spite of numerous recent outcome studies of extremely low birth weight (ELBW) infants, no data exist on their development prior to term. In this study we traced and compared the neurobehavioral development of 251 ELBW (< 1,000 g) and 240 low birth weight (LBW; 1,000 g–2,500 g) preterms born between 1995 and 2004 from 32 to 37 weeks postconceptional age (PCA), using the Neurobehavioral Assessment of the Preterm Infant (NAPI; Korner & Thom, 1990). Compared to the original NAPI cohort of 521 infants (born 1983–1989), the ELBW and LBW infants were at higher medical risk, displayed weaker motor development, a tighter scarf sign and popliteal angle at all or most PCAs, and a weaker cry at older PCAs; they did not differ in irritability and percent asleep ratings. Few differences were noted between the ELBW and LBW groups. Research is now needed to determine whether the 1995 to 2004 NAPI values of ELBW and LBW infants at 32 to 37 weeks PCA are predictive of later outcome of high-risk preterms.

Comparison between Neuroimaging and Neurobehavioral Assessments of the Very Low Birthweight Preterm Infant

Comparison between Neuroimaging and Neurobehavioral Assessments of the Very Low Birthweight Preterm Infant