Evaluation of the infant at risk for neurodevelopmental disability

Background. Infants with neurodevelopmental abnormality need to start therapy early, and because of this they should be detected as soon as possible. Currently, no widely accepted method of early evaluation exists. Objectives. To assess and compare, in terms of predicting neurodevelopmental outcome at 1 year of age: (i) a perinatal risk rating (PRR); (ii) the Dubowitz Neurological Assessment (DNA); and (iii) the Infant Neuromotor Assessment (INA). Design and setting. A prospective neurodevelopmental follow-up study on graduates from the Groote Schuur Hospital (GSH) neonatal intensive Care unit (NICU). Subjects. A cohort of 130 consecutive NICU graduates were selected according to high-risk criteria. Outcome measures. Each infant was examined at term gestational age on the DNA before discharge, and a PRR was allocated. Study infants were seen again at 18 weeks of age when an INA was done, and at 1 year of age a Griffiths Developmental Assessment and full neurological examination was carried out. Results. All of the 130 infants assessed at term were seen at 18 weeks. Thereafter 5 were lost to follow-up and 2 died. The outcome for the remaining 123 is known. Conclusions. Prediction of a normal outcome at 1 year of age was 96% on the DNA and 98% for the PRR, but for an abnormal outcome they predicted only 56% and 42%, respectively. The INA done at 18 weeks predicted a normal outcome at 1 year in 99% of cases if 3 or less abnormal signs were present and an abnormal outcome in 82% of cases with 4 or more abnormal signs. Based on these findings a protocol for follow-up of these high-risk infants is suggested.