Combined predictors of neurodevelopment in very low birth weight preterm infants

Pilar Medina-Alva, Kevin R Duque, Alonso Zea-Vera, Sicilia Bellomo, César Cárcamo, Daniel Guillen-Pinto, Maria Rivas, Alfredo Tori, Jaime Zegarra, Luis Cam, Anne Castañeda, Aasith Villavicencio, Theresa J Ochoa, Pilar Medina-Alva, Kevin R Duque, Alonso Zea-Vera, Sicilia Bellomo, César Cárcamo, Daniel Guillen-Pinto, Maria Rivas, Alfredo Tori, Jaime Zegarra, Luis Cam, Anne Castañeda, Aasith Villavicencio, Theresa J Ochoa

Abstract

Objective: To evaluate the combined prognostic value of neurological examination, head circumference and cranial ultrasound for neurodevelopmental delay (NDD) in very low birth weight (VLBW, <1500 g) preterm infants.

Methods: Prospective follow-up study. Preterm infants with VLWB were assessed for NDD using the Mullen Scales of Early Learning test at 24 months of corrected age. Abnormal neurological examination (≥2 deviant items of Hammersmith neurological examination), microcephaly and major ultrasound abnormalities, each performed at term age, were evaluated as predictors of NDD in a multivariable Poisson model.

Results: 35/132 infants (26.5%) had NDD. In the multivariable analysis, microcephaly (RR, 3.2; 95% CI, 1.6-6.7) and major ultrasound abnormalities (RR, 2.7; 95% CI, 1.3-5.7) were associated to NDD. The combination of the two tests showed the highest positive predictive value (100%; 95% CI, 51%-100%), while the combination of normal neurological examination, no major US findings and normal head size at term showed the highest negative predictive value (89%; 95% CI, 78%-95%). The maximum under receiver operating characteristic curve area was for microcephaly or major ultrasound abnormalities (AUC 0.74 (0.65-0.83)).

Conclusion: The combination of head circumference, cranial ultrasound and neurological examination at term age is useful to predict NDD in VLBW preterm infants.

Trial registration: ClinicalTrials.gov NCT01525316.

Keywords: Neurodevelopment; Predictive value; Predictors; Preterms.

Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

None to declare

Copyright © 2019 Elsevier B.V. All rights reserved.

Figures

Figure 1.
Figure 1.
Flow diagram of the prospective multicenter cohort study among VLBW infants, 2012–2014
Figure 2.
Figure 2.
Sensitivity versus specificity plot of five results among three examinations to predict neurodevelopmental delay in VLBW infants from a prospective multicenter cohort study, 2012–2014

Source: PubMed

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