ABSTRACT
Background: The Lacey Assessment of Preterm Infants (LAPI) is used in clinical practice to identify premature babies at risk of neuromotor impairments, especially cerebral palsy. There is a shortage of studies on the Lacey assessment despite its wide clinical use. This study attempted to find the diagnostic accuracy of the Lacey assessment of preterm infants to predict neuromotor outcomes of premature babies at 12 months corrected age and to compare their predictive ability with brain ultrasound. Methods: This prospective cohort study included 89 preterm infants (45 females & 44 males) born below 35 weeks gestation. An initial assessment was done using the Lacey Assessment of Preterm Infants (LAPI) after babies reached 33 weeks postmenstrual age. Follow up assessment on neuromotor outcomes was done at 12 months (±1 week) corrected age using two standardized outcome measures, i.e., Infant Neurological International Battery and Alberta Infant Motor Scale. Brain ultrasound data were collected retrospectively. Data were statistically analyzed, and the diagnostic accuracy of the Lacey Assessment of Preterm Infants (LAPI) alone and in combination with brain ultrasound was calculated. Results: Fisher's exact test showed p<.01, indicating that there is an association between the Lacey Assessment of Preterm Infants (LAPI) and the neuromotor outcomes at one year corrected age. A combination of Lacey Assessment (LAPI) and brain ultrasound results showed higher sensitivity in predicting abnormal neuromotor outcomes than Lacey Assessment alone (80% vs. 66.7%, respectively). Lacey Assessment also showed high specificity (96.3%) and negative predictive value (97.5%). Conclusion: Results of this study suggest that the Lacey Assessment of Preterm Infants (LAPI) can be used as a supplementary assessment tool for premature babies to identify those at risk of abnormal neuromotor outcomes. These findings have applications to identify premature babies eligible for early intervention services.
ABSTRACT
Recent advances in the technology of neonatal intensive care have greatly improved the survival rate of high-risk infants who would otherwise have died. However, the surviving infants still have higher risks of long-term neuro-developmental disabilities such as cerebral palsy. As a result, early intervention programs are advocated for the detection and remediation of neuromotor abnormalities in risk infants. A number of assessment scales and screening tools have been developed for the evaluation of infant neuromotor functions in western countries. Infant Neurological International Battery(INFANIB) was established by Ellison and Browning in 1985. INFANIB consists of assessment of posture, extremity and axial tone, primitive reflexes and postural reactions. This is relatively simple and easier for examiner and less burdensome to examinee. So we have used INFANIB as assessment tool for the detection of neurodevelopmental abnormal infants since 1993 and studied correlation between INFANIB results and neuromotor outcome for 2 years in 70 risk infants. All the infants of the abnormal results group (29 cases) on the initial INFANIB examination grew into either cerebral palsy (26 cases) or minor neural dysfunction group (3 cases) on the follow-up examinations. All the infants of the normal results group (12 cases) appeared to be in normal developmental outcomes on the follow up. However, the transient results group (29 cases) showed variable outcomes, which were 9 cases of cerebral palsy, 6 cases of minor neural dysfunctions, and 11 cases of normal development. INFANIB test results of the infants were highly sensitive and specific with the follow up examinations. Normal INFANIB results can be used to reassure parents of risk infants and an early intervention programs can be started to abnormal INFANIB infants. It can be used as a reliable screening tool for suspicious neurologically deviant neonates and infants. However the transient groups showed diverse neuromotor outcomes, they should be carefully monitored during infancy and childhood.