ORIGINAL ARTICLE

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

M J K de Kleine¹, A L den Ouden², L A A Kollée³, M W G Nijhuis- van der Sanden⁴, M Sondaar⁵, B J M van Kessel-Feddema⁶, S Knuijt⁷, A L van Baar⁸, A Ilsen⁹, R Breur-Pieterse⁹, J M Briët⁹, R Brand¹⁰, S P Verloove-Vanhorick¹¹

¹ Department of Neonatology, Máxima Medical Centre, Veldhoven, Netherlands
² TNO Prevention and Health, Leiden, Netherlands
³ Department of Paediatrics, University Medical Centre, Nijmegen, Netherlands
⁴ Department of Child Physiotherapy, University Medical Centre Nijmegen, Netherlands
⁵ Department of Medical Psychology, University Medical Centre, Nijmegen, Netherlands
⁶ Department of Medical Psychology, University Medical Centre, Nijmegen, Netherlands
⁷ Department of Neurology, University Medical Centre, Nijmegen, Netherlands
⁸ Department of Medical Psychology, Máxima Medical Centre, Veldhoven and Department of Neonatology, Academic Medical Centre, Amsterdam, Netherlands
⁹ Department of Neonatology, Academic Medical Centre, Amsterdam, Netherlands
¹⁰ Department of Medical Statistics, Leiden University Medical Centre, Netherlands
¹¹ TNO Prevention and Health, Leiden, and Professor of Child Health, Leiden University Medical Centre, Netherlands

Correspondence to:
Correspondence to:
Dr M J K de Kleine, Department of Neonatology, Máxima Medical Centre, PO Box 7777, 5500 MB Veldhoven, Netherlands;
m.dekleine{at}pg.tno.nl

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.

Keywords: follow up assessment; preterm infant; motor development; cognitive development; behaviour

Abbreviations: CBCL, Child Behavior CheckList; DDST, Denver Development Screening Test; ENT, ear, nose, and throat; NICU, neonatal intensive care units; TOMI, test of motor impairment; VLBW, very low birth weight

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Woodward, L J, Moor, S, Hood, K M, Champion, P R, Foster-Cohen, S, Inder, T E, Austin, N C (2009). Very preterm children show impairments across multiple neurodevelopmental domains by age 4 years. Arch. Dis. Child. Fetal Neonatal Ed. 94: 339-344 [Abstract] [Full Text]  
• Zeitlin, J., Draper, E. S., Kollee, L., Milligan, D., Boerch, K., Agostino, R., Gortner, L., Van Reempts, P., Chabernaud, J.-L., Gadzinowski, J., Breart, G., Papiernik, E., and the MOSAIC research group, (2008). Differences in Rates and Short-term Outcome of Live Births Before 32 Weeks of Gestation in Europe in 2003: Results From the MOSAIC Cohort. Pediatrics 121: e936-e944 [Abstract] [Full Text]  
• Hille, E. T. M., Weisglas-Kuperus, N., van Goudoever, J. B., Jacobusse, G. W., Ens-Dokkum, M. H., de Groot, L., Wit, J. M., Geven, W. B., Kok, J. H., de Kleine, M. J. K., Kollee, L. A. A., Mulder, A. L. M., van Straaten, H. L. M., de Vries, L. S., van Weissenbruch, M. M., Verloove-Vanhorick, S. P., for the Dutch Collaborative POPS 19 Study Group, (2007). Functional Outcomes and Participation in Young Adulthood for Very Preterm and Very Low Birth Weight Infants: The Dutch Project on Preterm and Small for Gestational Age Infants at 19 Years of Age. Pediatrics 120: e587-e595 [Abstract] [Full Text]  
• Reijneveld, S A, de Kleine, M J K, van Baar, A L, Kollee, L A A, Verhaak, C M, Verhulst, F C, Verloove-Vanhorick, S P (2006). Behavioural and emotional problems in very preterm and very low birthweight infants at age 5 years. Arch. Dis. Child. Fetal Neonatal Ed. 91: F423-F428 [Abstract] [Full Text]  
• Feldman, R., Eidelman, A. I. (2005). Does a Triplet Birth Pose a Special Risk for Infant Development? Assessing Cognitive Development in Relation to Intrauterine Growth and Mother-Infant Interaction Across the First 2 Years. Pediatrics 115: 443-452 [Abstract] [Full Text]  
• (2003). Illustrations, not run, but still fun!. Arch. Dis. Child. 88: 1140-1141 [Full Text]