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Abstract
Background Developmental outcomes of very preterm (gestational age ≤32 weeks) or very low birthweight (<1500g) children are commonly reported before age 3 years.
Aims To determine the validity of early developmental assessments in predicting school-age cognitive deficits in this population.
Methods English-language studies, identified through MEDLINE, in which at least 2 serial developmental/cognitive assessments (at ages 1–3 years and ≥5 years) were reviewed. For included studies, cross-tabulations of cognitive deficit (defined as test scores one SD below the population mean) identified by each assessment were constructed. With school-age assessment as the reference standard, the sensitivity and specificity of early assessment for cognitive deficit were calculated. We fitted a hierarchical summary receiver operator characteristic (HSROC) curve to obtain pooled estimates of sensitivity and specificity. Meta-regression was used to evaluate study and population characteristics associated with assessment validity.
Results Twenty-two studies (n = 2681 children) were included. Early assessment tools were Bayley Scales of Infant Development (14 studies), Griffiths Mental Development (5), Stanford-Binet Intelligence (2) and Brunet-Lezine (1) Scales; 11 different school-age cognitive tests were used. Assessments were conducted at 18–40 months for early and 5–18 years for school-age assessments. There was significant between-study heterogeneity in the reported sensitivities and specificities (figure 1, p < 0.01). Gestational age, birthweight, age at assessment and time difference between assessments did not explain between-study heterogeneity in results. From the HSROC curve (figure 2), pooled sensitivity (95% CI) was 0.55 (0.44–0.64) and specificity 0.84 (0.77–0.89).
Coupled forest plot of the sensitivity and specificity of early developemental assessment for school age cognitive deficit
Hierarchical summary receiver operator characteristic (HSROC) curve of study estimated sensitivity plotted against specificity
Conclusion Early developmental assessment had poor sensitivity but good specificity at predicting school-age cognitive deficits.