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Developmental Evaluations

As the survival rates of very preterm infants have improved with advances in perinatal and neonatal intensive care over the last 30 years, there has been increasing interest in the neurodevelopmental outcomes of preterm and high-risk infants. Assessment of neurodevelopmental and behavioral outcomes has also become a component of most randomized controlled trials of various therapies in the NICU. As such, there is a need to understand the neurodevelopmental tests that are used most commonly in the assessments of infants after discharge from the NICU, the ages at which they are appropriate, the information that they provide, and their predictive value for future outcomes. Properties such as reliability and validity, and specificity and sensitivity for diagnostic tests are also important to understand when interpreting results.

I. Patterns of development

  1. Typically developing infants

    1. Motor development in typically developing infants moves from reflexive movements to purposeful movements in a predictable pattern.

    2. Similarly, language comprehension and language production, problem-solving skills, and self-help skills develop in a stepwise fashion over the first years of life.

  2. Infants who are premature or high-risk

    1. Many of these skills may not be attained in the same timeframe as with typically developing children.

    2. Preterm infants should be assessed according to his/her corrected age for the first 2 years of life.

    3. Identifying delays in these infants is essential to making sure that proper therapies are instituted as soon as possible in order to maximize the abilities of the child.

    4. Assessment of preterm or high-risk infants at several time points over the first years of life will ensure that as new skills are emerging, delays are identified in a timely fashion.

    5. The skills that should be evaluated after discharge include

      1. Gross motor skills

      2. Fine motor skills

      3. Cognitive and developmental skills

      4. Self-help skills

      5. Language abilities

      6. Behavior and adjustment

II. Assessments tools

There are a variety of tools that are used to assess high-risk infants. These can be further broken down by the age at which they should be administered and the types of skills that they are designed to evaluate. This chapter does not include the full list of possible assessments; however, many of the tools used commonly in neonatal follow-up clinics and early intervention programs are described.

  1. Assessment of the neonate

    1. Neurologic

      The Amiel-Tison neurological assessment at term (ATNAT)

      1. Valid for both term infants and preterm infants at term equivalent.

      2. Takes about 5 to 10 minutes to complete.

      3. It works under the assumption that the upper and lower motor control systems develop individually and that injury in an infant most often occurs in the cerebral hemispheres and basal ganglia. Therefore, predictors of injury would be found in those responses that represent the upper motor control, including passive and active tone.

      4. It includes 36 items that are clustered in 10 domains and graded on a three-level system (mild, moderate, or severe) based on ...

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