Usefulness of Parent-Completed ASQ for Neurodevelopmental Screening of Preterm Children at Five Years of Age

Marie Halbwachs,Géraldine Gascoin,Sylvie Nguyen The Tich,Valérie Rouger,Bernard Branger,Jean-Baptiste Muller,Elise De La Rochebrochard,Jean-Christophe Rozé,Cyril Flamant

doi:10.1371/journal.pone.0071925

Abstract

IntroductionPreterm children are at greater risk of developmental impairment and require close follow-up for early and optimal medical care. Our goal was to examine use of the parent-completed Ages and Stages Questionnaire (ASQ) as a screening tool for neurodevelopmental disabilities in preterm infants at five years of age.Patients and MethodsA total of 648 preterm children (<35 weeks gestational age) born between 2003 and 2004 and included in the regional Loire Infant Follow-up network were evaluated at five years of age. ASQ was compared with two validated tools (Intelligence Quotient and Global School Adaptation Score) and the impact of maternal education on the accuracy of this questionnaire was assessed.ResultsOverall ASQ scores for predicting full-scale IQ<85 and GSA score produced an area under the receiver operating characteristic curve of 0.73±0.03 and 0.77±0.03, respectively. An ASQ cut-off value of 285 had optimal discriminatory power for identifying children with IQ scores<85 and GSA scores in the first quintile. ASQ values<285 were significantly associated with a higher risk of non-optimal neurologic outcomes (sensitivity of 0.80, specificity of 0.54 for IQ<85). ASQ values>285 were not distinctive for mild delay or normal development. In children with developmental delay, no difference was found when ASQ scores according to maternal education levels were analyzed.ConclusionsASQ at five years is a simple and cost-effective tool that can detect severe developmental delay in preterm children regardless of maternal education level, while its capacity to identify children with mild delay appears to be more limited.

Highlights

Preterm children are at greater risk of developmental impairment and require close follow-up for early and optimal medical care
The full-scale intelligence quotient (IQ) test constitutes the gold standard for evaluating children’s cognitive function, it can be regarded as inadequate because children born preterm can present disabilities in multiple domains such as speech, learning, behavior, cognition and attention, not all of which can be assessed with this instrument [14]
Cranial ultrasound scans were regularly conducted for preterm infants born at less than 34 weeks of gestational age, according to the screening protocol established by Perlman JM et al [35] to identify severe intraventricular hemorrhage (i.e IVH 3–4) and periventricular leukomalacia

Summary

Introduction

Preterm children are at greater risk of developmental impairment and require close follow-up for early and optimal medical care. The prevalence of cognitive disability and poor educational achievement is higher in this high-risk population, especially for those born very preterm [2] These children need close follow-up for at least five years [3,4] to facilitate early detection of elements that predict non-optimal neurodevelopment. The full-scale IQ test constitutes the gold standard for evaluating children’s cognitive function, it can be regarded as inadequate because children born preterm can present disabilities in multiple domains such as speech, learning, behavior, cognition and attention, not all of which can be assessed with this instrument [14] This test should be performed by a trained psychologist and requires a lot of time because it is lengthy, making it difficult to perform during routine examinations

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