Development and evaluation of a follow up assessment of preterm infants at 5 years of age

• Published in: Archives of disease in childhood 2003-10, Vol.88 (10), p.870-875
• Main Authors: de Kleine, M J K, den Ouden, A L, Kollée, L A A, van der Sanden, M W G Nijhuis, Sondaar, M, van Kessel-Feddema, B J M, Knuijt, S, van Baar, A L, Ilsen, A, Breur-Pieterse, R, Briët, J M, Brand, R, Verloove-Vanhorick, S P
• Format: Article
• Language: English
• Subjects: Age; and throat; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Behavior; behaviour; Biological and medical sciences; Care and treatment; CBCL; Cerebral palsy; Child Behavior CheckList; Child, Preschool; Children; Children & youth; Chronic illnesses; Cognitive development; Data Analysis; DDST; Denver Development Screening Test; Development; Developmental Disabilities - diagnosis; Developmental Disabilities - etiology; Diseases; ear; Education; Emergency and intensive care: neonates and children. Prematurity. Sudden death; ENT; Families & family life; follow up assessment; Follow-Up Studies; Health aspects; Health Status Indicators; Hospitals; Humans; Infant development; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Infants; Infants (Premature); Intellectual disabilities; Intensive care; Intensive care medicine; Intervention; Language Acquisition; Medical sciences; Methods; Mortality; motor development; Neonatal intensive care; neonatal intensive care units; NICU; nose; Original; Pediatric diseases; Pediatricians; Population; Practice; Predictive Value of Tests; Premature Infants; preterm infant; Prognosis; Psychometrics; Questionnaires; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Sick children; Standard deviation; Surveys and Questionnaires; test of motor impairment; TOMI; very low birth weight; VLBW
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.88.10.870

Background: Long term follow up shows a high frequency of developmental disturbances in preterm survivors of neonatal intensive care formerly considered non-disabled. Aims: To develop and validate an assessment tool that can help paediatricians to identify before 6 years of age which survivors have developmental disturbances that may interfere with normal education and normal life. Methods: A total of 431 very premature infants, mean gestational age 30.2 weeks, mean birth weight 1276 g, were studied at age 5 years. Children with severe handicaps were excluded. The percentage of children with a correctly identified developmental disturbance in the domains cognition, speech and language development, neuromotor development, and behaviour were determined. Results: The follow up instrument classified 67% as optimal and 33% as at risk or abnormal. Of the children classified as at risk or abnormal, 60% had not been identified at earlier follow up assessments. The combined set of standardised tests identified a further 30% with mild motor, cognitive, or behavioural disturbances. The paediatrician’s assessment had a specificity of 88% (95% CI 83–93%), a sensitivity of 48% (95% CI 42–58%), a positive predictive value of 85% (95% CI 78–91%), and a negative predictive value of 55% (95% CI 49–61%). Conclusions: Even after standardised and thorough assessment, paediatricians may overlook impairments for cognitive, motor, and behavioural development. Long term follow up studies that do not include detailed standardised tests for multiple domains, especially fine motor domain, may underestimate developmental problems.