TY - JOUR
T1 - Clinical tools used in young infants born very preterm to predict motor and cognitive delay (not cerebral palsy)
T2 - a systematic review
AU - Caesar, Rebecca
AU - Colditz, Paul B.
AU - Cioni, Giovanni
AU - Boyd, Roslyn N.
N1 - Funding Information:
RC is partially funded by research grants from the Health Practitioner Research Scheme, Queensland Health, and by Wishlist (Sunshine Coast Health Foundation). RB is supported by a National Health and Medical Research Council Fellowship and a National Health and Medical Research Council Centre of Research Excellence (Australian Cerebral Palsy Clinical Trials network). The authors have no conflict of interest to declare regarding their own research interests or any of the studies included in this review. The declared funding source of each study included in the review is outlined in Table S5 (online supporting information).
Publisher Copyright:
© 2020 Mac Keith Press
PY - 2020/4
Y1 - 2020/4
N2 - Aim: This systematic review evaluates the accuracy of clinical tools used at a corrected age of 6 months or younger to predict motor and cognitive delay (not cerebral palsy) at 24 months’ corrected age, in infants born very preterm. Method: Six databases were searched. Quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. Predictive analysis included calculation of sensitivity and specificity, inspection of summary receiver operating characteristics curves, and bivariate meta-analysis. Results: Six assessments were identified in 10 studies of 992 infants. Overall prevalence of motor delay was 13.8% and cognitive delay was 11.7%. Methodological quality was variable for patient selection, reference standard, flow, and timing. All studies had a low risk of bias for the index test. General Movement Assessment (GMA) predicted motor and cognitive outcomes with good accuracy for mild, moderate, and severe delays (fidgety age: pooled diagnostic odds ratio=12.3 [5.9–29.8]; hierarchical summary receiver operating characteristics curve=0.733). The Hammersmith Infant Neurological Examination (HINE) demonstrated excellent predictive accuracy for severe motor delay (3mo and 6mo; sensitivity 93% [68–100%], specificity 100% [96–100%]) but showed limited ability to predict milder delays. Interpretation: In the population of infants born very preterm, few assessment tools used at 6 months or younger corrected age have proven predictive accuracy for cognitive and motor delay at 24 months’ corrected age. Only the GMA and HINE demonstrated useful predictive validity. What this paper adds: General movements have predictive validity for both motor and cognitive dysfunction in infants born very preterm. The Hammersmith Infant Neurological Examination showed the highest predictive accuracy for severe motor delay. The General Movement Assessment was the best tool to predict mild-to-moderate motor and cognitive delays.
AB - Aim: This systematic review evaluates the accuracy of clinical tools used at a corrected age of 6 months or younger to predict motor and cognitive delay (not cerebral palsy) at 24 months’ corrected age, in infants born very preterm. Method: Six databases were searched. Quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. Predictive analysis included calculation of sensitivity and specificity, inspection of summary receiver operating characteristics curves, and bivariate meta-analysis. Results: Six assessments were identified in 10 studies of 992 infants. Overall prevalence of motor delay was 13.8% and cognitive delay was 11.7%. Methodological quality was variable for patient selection, reference standard, flow, and timing. All studies had a low risk of bias for the index test. General Movement Assessment (GMA) predicted motor and cognitive outcomes with good accuracy for mild, moderate, and severe delays (fidgety age: pooled diagnostic odds ratio=12.3 [5.9–29.8]; hierarchical summary receiver operating characteristics curve=0.733). The Hammersmith Infant Neurological Examination (HINE) demonstrated excellent predictive accuracy for severe motor delay (3mo and 6mo; sensitivity 93% [68–100%], specificity 100% [96–100%]) but showed limited ability to predict milder delays. Interpretation: In the population of infants born very preterm, few assessment tools used at 6 months or younger corrected age have proven predictive accuracy for cognitive and motor delay at 24 months’ corrected age. Only the GMA and HINE demonstrated useful predictive validity. What this paper adds: General movements have predictive validity for both motor and cognitive dysfunction in infants born very preterm. The Hammersmith Infant Neurological Examination showed the highest predictive accuracy for severe motor delay. The General Movement Assessment was the best tool to predict mild-to-moderate motor and cognitive delays.
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U2 - 10.1111/dmcn.14730
DO - 10.1111/dmcn.14730
M3 - Review article
C2 - 33185285
AN - SCOPUS:85096750817
SN - 0012-1622
VL - 63
SP - 387
EP - 395
JO - Developmental Medicine and Child Neurology
JF - Developmental Medicine and Child Neurology
IS - 4
ER -