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Development and evaluation of a follow up assessment of preterm infants at 5 years of age

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Author: Kleine, M.J.K. de · Ouden, A.L. den · Kollée, L.A.A. · Nijhuis - Sanden, M.W.G. van der · Sondaar, M. · Kessel van - Feddema, B.J.M. · Knuijt, S. · Baar, A.L. van · Ilsen, A. · Breur-Pieterse, R. · Briët, J.M. · Brand, R. · Verloove-Vanhorick, S.P.
Type:article
Date:2003
Source:Archives of Disease in Childhood, 10, 88, 870-875
Identifier: 237289
doi: doi:10.1136/adc.88.10.870
Keywords: Health · Birth weight · Child · Cognitive defect · Cognitive development · Controlled study · Developmental coordination disorder · Developmental disorder · Diagnostic accuracy · Disease classification · Disease severity · Evaluation · Female · Follow up · Gestational age · Language development · Major clinical study · Male · Medical assessment · Newborn intensive care · Pediatrician · Prematurity · Psychomotor development · Risk assessment · Speech development · Survival time · Child, Preschool · Developmental Disabilities · Follow-Up Studies · Health Status Indicators · Humans · Infant, Newborn · Infant, Premature · Infant, Very Low Birth Weight · Predictive Value of Tests · Prognosis · Psychometrics · Questionnaires · Reproducibility of Results · Risk Factors · Sensitivity and Specificity

Abstract

Background: Long term follow up shows a high frequency of developmental disturbances in preterm survivors of neonatal intensive care formerly considered non-disabled. Aims: To develop and validate an assessment tool that can help paediatricians to identify before 6 years of age which survivors have developmental disturbances that may interfere with normal education and normal life. Methods: A total of 431 very premature infants, mean gestational age 30.2 weeks, mean birth weight 1276 g, were studied at age 5 years. Children with severe handicaps were excluded. The percentage of children with a correctly identified developmental disturbance in the domains cognition, speech and language development, neuromotor development, and behaviour were determined. Results: The follow up instrument classified 67% as optimal and 33% as at risk or abnormal. Of the children classified as at risk or abnormal, 60% had not been identified at earlier follow up assessments. The combined set of standardised tests identified a further 30% with mild motor, cognitive, or behavioural disturbances. The paediatrician's assessment had a specificity of 88% (95% CI 83-93%), a sensitivity of 48% (95% CI 42-58%), a positive predictive value of 85% (95% CI 78-91%), and a negative predictive value of 55% (95% CI 49-61%). Conclusions: Even after standardised and thorough assessment, paediatricians may overlook impairments for cognitive, motor, and behavioural development. Long term follow up studies that do not include detailed standardised tests for multiple domains, especially fine motor domain, may underestimate developmental problems.