ABSTRACT
BACKGROUND: It is difficult to predict which preterm babies are most at risk for poor neurodevelopmental outcomes. A quick, highly predictive assessment tool would aid neonatal clinicians in making decisions about follow-up care. PURPOSE: The purpose of this study was to determine whether performance on the Premie-Neuro in the neonatal intensive care unit predicted neurodevelopmental outcomes at 3 months' adjusted age and 24 months' chronological age. METHODS: Thirty-four preterm infants were administered the Premie-Neuro in the neonatal intensive care unit. Infants were assessed using the Infanib and Alberta Infant Motor Scales at 3 months' adjusted age, and using the Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III) at 24 months' chronological age. Scores were analyzed to determine whether Premie-Neuro performance at less than 37 weeks postmenstrual age was predictive of neurodevelopmental outcomes at 3 months' adjusted age and 24 months' chronological age. RESULTS: Premie-Neuro raw scores were predictive of outcomes at 3 months' adjusted age and 24 months' chronological age. Premie-Neuro classifications were not predictive of Infanib and Alberta Infant Motor Scale classifications at 3 months' adjusted age but were predictive of Bayley-III classification at 24 months' chronological age. IMPLICATIONS FOR PRACTICE: Premie-Neuro raw scores may be used by the clinician to identify infants at risk for neurodevelopmental delays. Premie-Neuro classifications should be interpreted cautiously. IMPLICATIONS FOR RESEARCH: More research is needed to determine whether the Premie-Neuro may be used as an adjunct to clinical assessment to identify infants who are most at risk for developmental delay.
Subject(s)
Child Development , Developmental Disabilities/epidemiology , Intensive Care Units, Neonatal , Motor Skills , Neurologic Examination/methods , Aftercare , Child, Preschool , Developmental Disabilities/diagnosis , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Longitudinal Studies , Male , Neurodevelopmental Disorders/diagnosis , Neurodevelopmental Disorders/epidemiology , Reproducibility of Results , Risk AssessmentABSTRACT
PURPOSE: To determine the interrater and test-retest reliabilities and construct validity of the Premie-Neuro, a standardized neurologic assessment tool for preterm infants. SUBJECTS: Thirty-four preterm infants (mean gestational age at birth 29 ± 3.7 weeks, mean birth weight 1343.2 ± 696.3 g) participated in the study. DESIGN: A prospective repeated-measures design was used to assess the reliability and validity of the Premie-Neuro. METHODS: The Premie-Neuro was administered twice on consecutive days and then weekly through 37-weeks postmenstrual age or hospital discharge. At discharge, infants' medical histories were reviewed and a Neurobiologic Risk Score (NBRS) was used to determine risk for poor neurodevelopmental outcomes. MAIN OUTCOME MEASURE: Premie-Neuro raw scores and classifications were analyzed to determine the tool's reliability. Construct validity was measured by determining whether the Premie-Neuro could discriminate between infants identified as high-risk or low-risk for neurodevelopmental delays by using a NBRS of 5 as the cutoff for high- and low-risk infants. RESULTS: The intraclass correlation coefficients for interrater and test-retest reliability varied from 0.391 to 0.556 and from 0.493 to 0.592, respectively. Analysis of variance revealed that the Premie-Neuro raw scores for infants with NBRS > 5 were significantly worse than those for infants with NBRS < 5 (P = .000-.010). CONCLUSIONS: The Premie-Neuro is a valid assessment tool for discriminating between preterm infants at high and low risk for neurodevelopmental delay. Interrater reliability of the Premie-Neuro was poor, and test-retest reliability of the Premie-Neuro was fair to moderate. The Premie-Neuro may be acceptable for assessing groups of infants, but there is no evidence that reliability is sufficient for clinical decision-making for individual infants. More research needs to be done to improve the reliability of the Premie-Neuro and assess other facets of the Premie-Neuro's reliability.
Subject(s)
Infant, Premature/growth & development , Intensive Care, Neonatal , Neonatal Screening , Neurologic Examination , Child Development , Gestational Age , Humans , Infant, Low Birth Weight , Infant, Newborn , Intensive Care, Neonatal/methods , Intensive Care, Neonatal/standards , Male , Neonatal Screening/methods , Neonatal Screening/standards , Neurologic Examination/methods , Neurologic Examination/standards , Patient Discharge , Prospective Studies , Reference Values , Reproducibility of Results , Risk Assessment/methods , Risk Assessment/standardsABSTRACT
BACKGROUND: Interactions suggest that anesthetic and analgesic strategies could be used to modulate immune function and reduce nosocomial infection in critically ill pediatric patients. However, this theory has yet to be adequately tested. OBJECTIVE: To present the evidence for interactions between nociceptive and immune pathways. DATA SOURCES: The MEDLINE database and hand searches of the English-language biomedical literature for the 1985-2003 period. DATA SYNTHESIS: Substantial evidence exists for numerous bidirectional relationships between nociceptive and immune pathways. Some studies suggest that surgical pain and stress may alter immune function in adults. Limited evidence indicates that anesthetic and analgesic immunomodulation may boost immune function to prevent nosocomial infection. However, unique aspects of immune function maturation and neurodevelopment must be considered. CONCLUSION: Research is urgently needed to determine if the interactions between nociceptive and immune function pathways in critically ill infants and children are similar to those in adults and if host defenses can be enhanced by optimal anesthetic and analgesic strategies.
