Joy E. Olsen

Neurobehaviour at term-equivalent age and neurodevelopmental outcomes at 2 years in infants born moderate-to-late preterm

To examine the association between newborn neurobehavioural assessments and neurodevelopmental outcomes at 2 years in infants born moderate‐to‐late preterm (MLPT).

Participation of children with ABI and the relationship with discharge functional status

Aims: To investigate the relationship between childrens functional status at discharge from inpatient rehabilitation and participation in home, school and community life following paediatric acquired brain injury (ABI). Methods: The Child and Adolescent Scale of Participation (CASP) was mailed to 60 families of school-aged children who had sustained an ABI. Functional status data was obtained from the hospital database. Twenty-eight families participated in the study. Results: No statistically significant correlations between functional status at discharge and participation levels were found. Conclusions: The lack of correlation raised questions regarding the sensitivity of the PEDI and the CASP. Therapists should consider the implication that children who perform well in functional tasks on the PEDI at discharge may not necessarily participate at age-expected levels upon return home. Environmental and child factors that hinder or support participation, such as physical infrastructure and impairments resulting from paediatric ABI, need to be considered when planning services.

Reliability of Neurobehavioral Assessments from Birth to Term Equivalent Age in Preterm and Term Born Infants

ABSTRACT Neurobehavioral assessments provide insight into the functional integrity of the developing brain and help guide early intervention for preterm (<37 weeks’ gestation) infants. In the context of shorter hospital stays, clinicians often need to assess preterm infants prior to term equivalent age. Few neurobehavioral assessments used in the preterm period have established interrater reliability. Aim: To evaluate the interrater reliability of the Hammersmith Neonatal Neurological Examination (HNNE) and the NICU Network Neurobehavioral Scale (NNNS), when used both preterm and at term (>36 weeks). Methods: Thirty-five preterm infants and 11 term controls were recruited. Five assessors double-scored the HNNE and NNNS administered either preterm or at term. A one-way random effects, absolute, single-measures interclass correlation coefficient (ICC) was calculated to determine interrater reliability. Results: Interrater reliability for the HNNE was excellent (ICC > 0.74) for optimality scores, and good (ICC 0.60–0.74) to excellent for subtotal scores, except for ‘Tone Patterns’ (ICC 0.54). On the NNNS, interrater reliability was predominantly excellent for all items. Interrater agreement was generally excellent at both time points. Conclusions: Overall, the HNNE and NNNS neurobehavioral assessments demonstrated mostly excellent interrater reliability when used prior to term and at term.

Preterm and term‐equivalent age general movements and 1‐year neurodevelopmental outcomes for infants born before 30 weeks' gestation

To examine the associations between Prechtls General Movements Assessment (GMA), conducted from birth to term‐equivalent age, and neurodevelopmental outcomes at 12 months corrected age, in infants born very preterm.

NICU Graduates: The Role of the Allied Health Team in Follow-Up

Infants who graduate from the neonatal intensive care unit, including those infants born preterm and/or with brain injury, are at increased risk of long-term neurodevelopmental impairments. The developmental allied health team, consisting of physical therapy, occupational therapy, and speech pathology, is crucial in early evaluation of gross motor, fine motor, feeding, and language development. Surveillance of neurodevelopment in the first year of life is essential to ensure early detection of specific developmental delays and impairments, and to ensure timely referral for early intervention. Early intervention is not only important in optimizing long-term outcomes for the child, but it also plays an important role in enhancing the parent-child relationship and parental well-being. In this review, we discuss the role of the developmental allied health team in the follow-up of high-risk infants, identify key assessment tools used in early neurodevelopmental surveillance, and provide recommendations regarding referral to intervention programs to optimize child and family outcomes. [Pediatr Ann. 2018;47(4):e165-e171.].

Neuropredictors of oromotor feeding impairment in 12 month-old children

BACKGROUND Feeding impairment is prevalent in children with neurodevelopmental issues. Neuroimaging and neurobehavioral outcomes at term are predictive of later neuromotor impairment, but it is unknown whether they predict feeding impairment. AIMS To determine whether neurobehavior and brain magnetic resonance imaging (MRI) at term predict oromotor feeding at 12 months in preterm and term-born children. STUDY DESIGN Prospective cohort study. SUBJECTS 248 infants (97 born <30 weeks and 151 born at term) recruited at birth. OUTCOME MEASURES Neurobehavioral assessments (General Movements (GMA), Hammersmith Neonatal Neurological Examination (HNNE), Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS)); and brain MRI were administered at term-equivalent age. Oromotor feeding was assessed at 12 months corrected age using the Schedule for Oral Motor Assessment. RESULTS 49/227 children had oromotor feeding impairment. Neurobehavior associated with later feeding impairment was: suboptimal NNNS stress (odds ratio [OR] 2.68; 95% confidence interval [CI] 1.20–6.01), non-optimal reflexes (OR 3.33; 95% CI 1.37–8.11) and arousal scales (OR 2.54; 95% CI 1.03–6.27); suboptimal HNNE total (OR 4.69; 95% CI 2.20–10.00), reflexes (OR 2.62; 95% CI 1.06–6.49), and tone scores (OR 3.87; 95% CI 1.45–10.35); and abnormal GMA (OR 2.60; 95% CI 1.21–5.57). Smaller biparietal diameter also predicted feeding impairment (OR 0.88; 95% CI 0.79–0.97). There was little evidence that relationships differed between birth groups. CONCLUSIONS Neurobehavior and biparietal diameter at term are associated with oromotor feeding at 12 months. These results may identify children at greatest risk of oromotor feeding impairment.

Late preterm births: New insights from neonatal neuroimaging and neurobehaviour

With increasing evidence of neurodevelopmental problems faced by late preterm children, there is a need to explore possible underlying brain structural changes. The use of brain magnetic resonance imaging has provided insights of smaller and less mature brains in infants born late preterm, associated with developmental delay at 2 years. Another useful tool in the newborn period is neurobehavioural assessment, which has also been shown to be suboptimal in late preterm infants compared with tern infants. Suboptimal neurobehaviour is also associated with poorer 2-year neurodevelopment in late preterm infants. More research into these tools will provide a better understanding of the underlying processes of developmental deficits of late preterm children. The value of their role in clinical care remains to be determined.

Do fidgety general movements predict cerebral palsy and cognitive outcome in clinical follow-up of very preterm infants?

Infants born very preterm (<32 weeks’ gestation) have increased risk for cerebral palsy (CP) compared with their term-born peers and are often included in developmental follow-up programmes to allow early detection of CP and identify as soon as possible, those infants who will require specific intervention. The Prechtl General Movements Assessment (GMA) evaluates the quality of infants’ spontaneous movements and has excellent predictive validity for CP (1), with the highest sensitivity and specificity between nine and 16 weeks when ‘fidgety’ general movements (small-amplitude movements in all directions of variable acceleration and moderate speed throughout the whole body) are present. The GMA also offers considerable utility as it is observational and is increasingly used by clinicians in preterm follow-up programmes (2). The recent study by Datta et al. examined the predictive validity of GMA at three months’ corrected age for CP and other neurodevelopmental impairment for 535 infants born very preterm seen as part of developmental followup across three centres. The study has two key findings. Firstly, that within a clinical context, the GMA at three months is a useful tool for predicting CP for very preterm infants, in agreement with previous research (1,2). Absent fidgety GMA was associated with CP at two years’ corrected age, and predictive accuracy for CP increased when combined with brain injury on neonatal cranial ultrasound. The GMA therefore provides valuable information as part of the clinical assessment comprising neuroimaging, clinical history and other neurodevelopmental assessment (1). A second finding was the association between absent fidgety GMA and poorer cognitive outcome, similar to previous studies (3). However, it should be noted that the association was weaker when children with CP were excluded, given the high incidence of cognitive impairment in children with CP (1). Rather than predicting cognitive outcomes, abnormal GMA findings may help clinicians identify infants who warrant closer follow-up of their cognitive development (4). As a qualitative, observational assessment, there are important methodological considerations to ensure the reliability and subsequent predictive validity of the GMA in clinical follow-up. This was not a prospective cohort study with clear eligibility criteria, and it should be noted that the follow-up rate was low at 28.5%. Previous clinical follow-up studies have used double-scorers and reviewed ambiguous cases (2). While Datta et al. reported specificity of the GMA that was similarly high to other studies, sensitivity was lower. There were also differences in the sensitivity and specificity between centres, which the authors attributed to rater differences (although inter-rater reliability was not reported). The GMA is usually scored from video, necessitating additional time to the standard clinic visit. Guzzetta et al. (5) compared the predictive validity of GMA through direct observation and GMA scored from video. The predictive validity of both methods was high, as was the correlation between the two methods; however, 6% of cases could not be definitively scored from direct observation. They concluded that direct observation was similarly sensitive as GMA scored from video, however, recommended videoed assessment for cases that were not clear. In clinical practice, there is scope to use technology, such as smartphone applications (6), for parents to upload a video for GMA prior to their clinic visit. Clinicians can then determine whether further GMA is required, and organise additional measures such as brain magnetic resonance imaging for infants with abnormal GMA, to increase the predictive accuracy for neurodevelopmental outcome, such as CP, and thereby target early intervention. URL TO THE FULL REVIEW ON THE EBNEO WEB SITE https://ebneo.org/2017/11/do-fidgety-generalmovements-predict-cerebral-palsy-and-cognitiveoutcome-in-clinical-follow-up-of-very-preterminfants

Continuum of neurobehaviour and its associations with brain MRI in infants born preterm

Background Infants born very preterm (VPT) and moderate-to-late preterm (MLPT) are at increased risk of long-term neurodevelopmental deficits, but how these deficits relate to early neurobehaviour in MLPT children is unclear. The aims of this study were to compare the neurobehavioural performance of infants born across three different gestational age groups: preterm <30 weeks’ gestational age (PT<30); MLPT (32–36 weeks’ gestational age) and term age (≥37 weeks’ gestational age), and explore the relationships between MRI brain abnormalities and neurobehaviour at term-equivalent age. Methods Neurobehaviour was assessed at term-equivalent age in 149 PT<30, 200 MLPT and 200 term-born infants using the Neonatal Intensive Care UnitNetwork Neurobehavioral Scale (NNNS), the Hammersmith Neonatal Neurological Examination (HNNE) and Prechtl’s Qualitative Assessment of General Movements (GMA). A subset of 110 PT<30 and 198 MLPT infants had concurrent brain MRI. Results Proportions with abnormal neurobehaviour on the NNNS and the HNNE, and abnormal GMA all increased with decreasing gestational age. Higher brain MRI abnormality scores in some regions were associated with suboptimal neurobehaviour on the NNNS and HNNE. The relationships between brain MRI abnormality scores and suboptimal neurobehaviour were similar in both PT<30 and MLPT infants. The relationship between brain MRI abnormality scores and abnormal GMA was stronger in PT<30 infants. Conclusions There was a continuum of neurobehaviour across gestational ages. The relationships between brain abnormality scores and suboptimal neurobehaviour provide evidence that neurobehavioural assessments offer insight into the integrity of the developing brain, and may be useful in earlier identification of the highest-risk infants.