rather than just severe impairment, in ongoing monitoring, according to a study published in Pediatrics.
Carmina Erdei, MD, of Brigham and Women’s Hospital and the department of pediatrics at Harvard Medical school, both in Boston, and colleagues prospectively studied 103 children born VPT (32 weeks’ or less gestation) and 109 children born term. Exclusion criteria included congenital abnormalities and having non–English-speaking parents.
The investigators assessed the children’s cognitive abilities and neurodevelopment with age-appropriate measures at various ages: Bayley Scales of Infant Development (2nd ed.) at age 2 years, Wechsler Preschool and Primary Scale of Intelligence at age 4 and 6 years, and Wechsler Intelligence Scale for Children (4th ed.) at age 9 and 12 years.
When only severe cognitive impairment at ages 2, 4, and 6 years was used as the criterion for ongoing monitoring, between 18% and 44% of severely impaired children at 12 years were missed – and would not have received continued monitoring and support. However, when any cognitive impairment at the younger ages was the criterion for continued monitoring, 100% of cases of severe impairment at age 12 years were correctly predicted.
The authors suggest that adoption of this more inclusive approach may be warranted, given the long-term ramifications of even mild cognitive impairment.
Positive predictive value (66%), negative predictive value (89%), and specificity (73%) intersected in assessments performed at age 6 years, such that they had the best predictive ability for any cognitive impairment at age 12 years.
“Our findings highlight the potential benefit of monitoring children at high risk with early delay until elementary school,” the authors wrote. “We acknowledge that this would result in a higher number of referrals and potentially increased short-term costs. Developmental follow-up is costly, yet early developmental services are valuable and positively impact preterm children’s cognitive and preacademic skills.”
The investigators also assessed family-social risks, such as socioeconomic status and maternal education, and found that children born VPT were more than twice as likely to be raised in families with more risks than were those born term (33% vs. 13%, respectively).
Limitations of the study include the high false-positive rate (34%) seen with the assessments at age 6 years, but the authors suggested that could be mitigated with risk stratification.
The study was funded by the Neurological Foundation, Lottery Grants Board, Canterbury Medical Research Foundation, and Health Research Council of New Zealand. The authors reported having no relevant financial relationships or conflicts of interest.
SOURCE: Erdei C et al. Pediatrics. 2020 Mar 6. doi: 10.1542/peds.2019-1982.