Validation of the Motor Functional Development Scale for Young Children to predict motor outcome in preterm infants: A 2 years follow-up study.

OBJECTIVE: To examine the validity of the Motor Functional Development Scale for Young Children (DF-mot) to predict motor developmental delays in preterm infants. METHOD: This retrospective cohort study includes 67 preterm infants who were assessed at 3-5 months by the DF-mot and the Alberta Infant Motor Scale (AIMS); and at 22-25 months by the Bayley Scales of Infant-Toddler Development (Bayley-III). The properties of the DF-mot and the AIMS were examined based on their ability to predict motor delays on the Bayley-III. RESULTS: The DF-mot gross motor subscale -2 SD and the AIMS 10th centile showed best balance between sensitivity and specificity (respectively Se = 57.1%, Sp = 71.7% and Se = 50%, Sp = 73.5%). Overall, the DF-mot fine motor subscale fails to predict motor delays. CONCLUSION: The DF-mot shows a lack of sensitivity and of positive predictive value to accurately predict motor outcome at 2 years in preterm infants. ABBREVIATIONS: CA, Corrected age; AIMS, Alberta Infant Motor Scale; DF-mot/PML, Motor Functional Development Scale for Young Children postural motor locomotor; DF-mot/EHGC, Motor Functional Development Scale for Young Children eye-hand grip coordination; Bayley-III/GM, Gross motor subscale of the Bayley Scales of Infant-Toddler Development Third Edition; Bayley-III/FM, Fine motor subscale of the Bayley Scales of Infant-Toddler Development Third Edition.

Comparative validity between the Canadian and the Dutch norms of the Alberta Infant Motor Scale in a preterm population.

BACKGROUND: Prematurity remains a leading cause of motor developmental delays. The Alberta Infant Motor Scales (AIMS) is a useful tool to easily assess motor development. However, during the last decade, cross-cultural differences have been identified regarding the original AIMS norms. Therefore, the aim of this study is twofold: confirm the validity of the AIMS in a preterm population and compare the new Dutch AIMS norms to the original Canadian ones in our Belgian population. METHOD: Ninety-six preterm infants were assessed simultaneously on the AIMS and on the Bayley Scales of Infant-Toddler Development (Bayley-III) at age 9-14 months. Concurrent validity was evaluated by correlation analysis. Among these, 89 were assessed on the AIMS at age 3-6 months. Clinimetric properties of both AIMS norms were calculated to compare their ability to detect a motor delay on the Bayley-III at age 9-14 months. RESULT: Pearson's coefficient showed an excellent level of correlation between the two scales (r = 0.91). At age 3-6 months, only the 10th Canadian centile showed acceptable properties to predict a significant motor delay. At age 9-14 months, the 5th centile of both norms showed good properties to diagnose a significant motor delay, while only the Canadian norms seems to be sensitive enough to diagnose a mild motor delay. CONCLUSION: The new Dutch norms seem to be less sensitive but more specific than the Canadian ones and therefore require adapted cut-offs to diagnose motor developmental delays in a preterm population.

Impact of COVID-19 pandemic on postpartum depression among mothers of extreme and early preterm infants.

OBJECTIVE: To examine the impact of the coronavirus disease 2019 (COVID-19) pandemic and the resulting isolation measures on the risk of postpartum depression (PPD) after preterm birth. METHODS: This is a cross-sectional study of mothers of extreme and early preterm infants who completed the Edinburgh Postnatal Depression Scale (EPDS) at the standardized 3-6 months follow-up consultation for preterm infants. Mothers assessed during the COVID-19 pandemic (n = 34; from April 1, 2020 to March 31, 2021) were compared with an antecedent control group (n = 108; from January 1, 2017 to December 31, 2019). A multivariable logistic regression model was used to examine the relationship between the pandemic and the risk of PPD (EPDS score ≥13). RESULTS: The prevalence of depressive symptoms was significantly higher in the COVID-19 study group (26% versus 12%, P = 0.043). The multivariable logistic regression model showed a significant association between the COVID-19 pandemic and the risk of PPD (adjusted odds ratio 3.60, 95% confidence interval 1.06-12.59, P = 0.040). CONCLUSION: Among mothers of extreme and early preterm infants, the COVID-19 pandemic was independently associated with a higher risk of PPD. This confirms the need for a close and long-term follow up of maternal psychological health after preterm birth.

Concurrent and predictive validity of the Motor Functional Development Scale for Young Children in preterm infants.

BACKGROUND: The Motor Functional Development Scale for Young Children (DF-mot) is a developmental tool assessing both gross and fine motor skills in term infants. AIMS: To examine the concurrent validity of the DF-mot with the Alberta Infants Motor Scale (AIMS) in preterm infants and compare their ability in predicting scores on the Bayley Scales of Infant-Toddler Development (Bayley-III) at 12 months. STUDY DESIGN: Retrospective cohort study. SUBJECTS AND OUTCOME MEASURES: Hundred and eleven infants born at less than 32 weeks' gestation or with a birthweight less than 1500 g were assessed simultaneously on the DF-mot and the AIMS at age 3-5 months. Correlation analysis was used to determine the strength of association between the DF-mot and the AIMS. Among these, 62 were reassessed on the Bayley-III at age 9-12 months. Clinimetric properties were calculated to evaluate their ability to predict motor delay on the Bayley-III. RESULTS: The concurrent validity study found a good level of correlation between the two scales (r = 0.79). The predictive validity study showed good sensitivity and negative predictive value for the AIMS 25th centile and the DF-mot -1 standard deviation to predict motor delay at 12 months (respectively Se = 100% and 84%; NPV = 100% and 77.8%). CONCLUSIONS: The DF-mot is a valid instrument with good predictive validity in preterm infants, suggesting it can be used as a clinical useful tool to assess motor development.

End-of-life decisions and practices for very preterm infants in the Wallonia-Brussels Federation of Belgium.

BACKGROUND: Very preterm birth (24 to < 32 week's gestation) is a major public health issue due to its prevalence, the clinical and ethical questions it raises and the associated costs. It raises two major clinical and ethical dilemma: (i) during the perinatal period, whether or not to actively manage a baby born very prematurely and (ii) during the postnatal period, whether or not to continue a curative treatment plan initiated at birth. The Wallonia-Brussels Federation in Belgium counts 11 neonatal intensive care units. METHODS: An inventory of key practices was compiled on the basis of an online questionnaire that was sent to the 65 neonatologists working in these units. The questionnaire investigated care-related decisions and practices during the antenatal, perinatal and postnatal periods, as well as personal opinions on the possibility of standardising and/or legislating for end-of-life decisions and practices. The participation rate was 89% (n = 58). RESULTS: The results show a high level of homogeneity pointing to overall agreement on the main principles governing curative practice and the gestational age that can be actively managed given the current state of knowledge. There was, however, greater diversity regarding principles governing the transition to end-of-life care, as well as opinions about the need for a common protocol or law to govern such practices. CONCLUSION: Our results reflect the uncertainty inherent in the complex and diverse situations that are encountered in this extreme area of clinical practice, and call for qualitative research and expert debates to further document and make recommendations for best practices regarding several "gray zones" of end-of-life care in neonatology, so that high quality palliative care may be granted to all neonates concerned with end-of-life decisions.