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Early Outcome Determination of Low-Birth-Weight Infants Using the Neurodevelopmental Risk Examination

Departments of Pediatrics and Child and Adolescent Psychiatry, Schneider Children's Hospital, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York

Lisa A. Altshuler

Departments of Pediatrics and Child and Adolescent Psychiatry, Schneider Children's Hospital, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York

A neonatal neurodevelopmental assessment, the Neurodevelopmental Risk Examination (NRE), was developed, through adaptation of the scoring of the Allen/Capute neonatal neurodevelopmental examination, for screening the development of low-birth-weight (LBW) infants in the newborn period. A pilot study was conducted of the NRE and its ability to predict motor and cognitive outcome in LBW infants. The NRE was performed on 92 LBW infants (mean birth weight 1,192 g; mean gestational age 29 weeks) at or near term and included assessments of sensory/behavioral response, axial tone, extremity tone, deep tendon reflexes, and primitive reflexes. Developmental outcome was assessed at a mean age of 13.7 months by neuromotor examination and by the mental scale of the Bayley Scales of Infant Development. The NRE total risk score, reflecting overall neurodevelopmental status, correlated well with motor and cognitive outcomes (r = .50, P=.0001 ; and r = -.38, P = .0001, respectively). When infants were clustered into risk groups based upon NRE score (69 infants were deemed low-risk, 20 moderate-risk, and three high-risk) , a strong relationship to outcome was maintained (motor outcome: ² = 43.6, P<.0001 ; cognitive outcome: analysis of variance (ANOVA) F = 6.78, df(2,89), P = .002). All subcategories of the examination, except primitive reflexes, were associated with outcome. Therefore, by using a simple method of scoring and interpretation, the NRE can validly predict motor and cognitive outcome in LBW infants.

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