Abstract
Background: Extremely low birth weight infants are at increased risk for neurodevelopmental disabilities. It would be useful to determine if preschool screening could predict which children will be normal at school age so follow-up resources could be directed to those at greatest risk.
Objective: To determine if neurodevelopmental assessment at 3 yrs of age is predictive of outcome findings at 8 yrs of age for children who were <801 g BW.
Methods: All surviving infants 450 to 800 g BW cared for at hospitals associated with UMKC School of Medicine were enrolled in a multidisciplinary follow-up clinic. Children were evaluated with a standard battery of cognitive, motor, and language tests. At 3 and 8 yrs, outcomes of children were categorized by composite results as having major disability, mild disability, or normal, according to pre-established criteria (Kilbride, Daily, J Perinatol 1998;18:102). The relationship between the neurodevelopmental category at 3 yrs and outcome measures at 8 yrs was assessed by ordinal logistic regression analysis, controlling for confounding variables (GA, BW, SES, and IVH).
Results: 149 children were evaluated. Mean BW (range) was 702±80 g (490–800) and GA, 25.8±1.5 weeks (23–31). There was no significant relationship between BW or GA and outcome at 8 yrs. Infants without IVH were statistically more likely to be categorized as normal (51% vs 31%, grade I–II and 27%, grade III–IV, P=.04), and had higher IQ scores (89±15 vs 82±19, grade I-II and 82±17, grade III-IV). IQ scores were also related to SES (high SES, 90±15 and low SES, 82±19, P=.05). Independent of these variables, neurodevelopmental categorization at 3 yrs was highly correlated with 8-yr outcome findings (P <.000). At 3 yrs of age, 20% (43/149) were considered normal, 54% (80/149) mildly disabled, and 19% (26/149) had major disability. For those with a normal assessment at 3 yrs, 84% were considered normal and 16% mildly disabled at 8 yrs. None of these children had major disability. For those with mild disability at 3 yrs, 31% were normal and 10% had major disability at 8 yrs. 81% of those with major disabilities at 3 yrs remained in that category at 8 yrs; the other 19% were categorized as having mild disability. Overall, between 3 and 8 yrs, outcome status improved for 20% and declined for 10% of children.
Conclusion: No child identified as normal at 3 yrs was found to have a major disability at 8 yrs of age. An evaluation at 3 yrs of age using composite categorization of cognitive, motor, and neurosensory assessments may accurately predict functional outcome at school age.
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Kilbride, H. Three-Year Assessment is Predictive of Outcome at 8 Years of Age for Elbw Survivors.. Pediatr Res 56, 670 (2004). https://doi.org/10.1203/00006450-200410000-00044
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DOI: https://doi.org/10.1203/00006450-200410000-00044