Validity of neurodevelopmental outcomes of children born very preterm assessed during routine clinical follow-up in England

Abstract

ObjectiveTo determine the validity of assessing and recording the neurodevelopmental outcome of very preterm infants during routine clinical follow-up in England.DesignChildren 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.Results190 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.ConclusionsNeurodevelopmental 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.