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Clinical tools used in young infants born very preterm to predict motor and cognitive delay (not cerebral palsy): a systematic review
Author(s) -
Caesar Rebecca,
Colditz Paul B,
Cioni Giovanni,
Boyd Roslyn N
Publication year - 2021
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.14730
Subject(s) - cerebral palsy , receiver operating characteristic , diagnostic odds ratio , predictive validity , cognition , pediatrics , population , odds ratio , bivariate analysis , medicine , audiology , psychology , physical medicine and rehabilitation , developmental psychology , psychiatry , statistics , environmental health , mathematics
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.