Validity of neurodevelopmental outcomes of children born very preterm assessed during routine clinical follow-up in England
File(s)
Accepted version
Author(s)
Wong, Hilary S
Cowan, Frances M
Modi, Neena
Medicines for Neonates Investigator Group
Type
Journal Article
Abstract
OBJECTIVE: To determine the validity of assessing and recording the neurodevelopmental outcome of very preterm infants during routine clinical follow-up in England. DESIGN: Children born <30 weeks gestation, attending routine clinical follow-up at post-term ages 20-28 months, were recruited. Data on neurodevelopmental outcomes were recorded by the reviewing clinician in a standardised format in the child's electronic patient record, based on a set of key questions designed to be used without formal training or developmental testing. Using a predefined algorithm, each participant was classified as having 'no', 'mild/moderate' or 'severe' impairment in cognitive, communication and motor domains. All participants also received a research assessment by a single assessor using the Bayley Scales of Infant Development, third edition (Bayley-III). The sensitivity and specificity of routine data in capturing impairment (any Bayley-III score <85) or severe impairment (any Bayley-III score <70) was calculated. RESULTS: 190 children participated. The validity of routine assessments in identifying children with no impairment and no severe impairment was high across all domains (specificities 83.9%-100.0% and 96.6%-100.0%, respectively). However, identification of impairments, particularly in the cognitive (sensitivity 69.7% (55.1%-84.3%)) and communication (sensitivity (53.2% (42.0%-64.5%)) domains, was poor. CONCLUSIONS: Neurodevelopmental status determined during routine clinical assessment lacks adequate sensitivity in cognitive and communication domains. It is uncertain whether this reflects the assessment or/and the recording of findings. As early intervention may improve education and social outcomes, this is an important area for healthcare quality improvement research.
Date Issued
2018-09-01
Date Acceptance
2017-09-28
Citation
Archives of Disease in Childhood. Fetal and Neonatal Edition, 2018, 103, pp.F497-F484
ISSN
1359-2998
Publisher
BMJ Publishing Group
Start Page
F497
End Page
F484
Journal / Book Title
Archives of Disease in Childhood. Fetal and Neonatal Edition
Volume
103
Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Sponsor
National Institute for Health Research
Identifier
PII: archdischild-2016-312535
Grant Number
N/A
Subjects
electronic health records
neurodevelopment
preterm birth
Publication Status
Published
Date Publish Online
2017-10-27