Intensive Care Unit Follow-up Clinic Research Articles

Transient Neurologic Signs in Infancy and Motor Outcomes at 4 1/2 Years in Children Born Biologically At Risk

This study was designed to investigate the effects of transient neurologic signs evident in infancy on motor outcomes in 41/2-year-old children born biologically at risk. Children who appeared neurologically normal at each of the 4-month, 12-month, and 24-month visits in the Neonatal Intensive Care Unit Follow-Up Clinic were assigned to the neurologically normal (NN) group ( n = 42). Children who appeared to have neuromotor abnormalities at either or both the 4-month and 12-month visits, and who were then rated as “normal” at the 24-month visit, were assigned to the transient neurological signs (TNS) group ( n = 19). The groups were compared on motor and cognitive measures at the 41/2-year clinic visit. No significant differences between groups were found except on the measure of pencil prehension, in which the TNS group scored significantly lower ( p < .01) than the NN group. A more thorough assessment of fine motor skills at the preschool level may be indicated when following the neurodevelopmental course of children born biologically at risk.

Effectiveness of the Denver Developmental Screening Test with Biologically Vulnerable Infants

The Denver Developmental Screening Test (DDST) was initially developed specifically to identify children with mental retardation. However, its use in screening low birth weight and other biologically at-risk infants for motor problems is widespread. In view of the absence of biologically vulnerable children in the DDST standardization sample, and the limited validational support available for its use with children under 30 months of age, the purpose of this study was to investigate the effectiveness of the DDST in screening 62 Neonatal Intensive Care Unit graduates during infancy. Categorical results (Normal, Questionable, Abnormal), obtained in the home setting by DDST, were compared with results of Neonatal Intensive Care Unit Follow-up Clinic evaluations. There was a marked underselection of the DDST's categorical results in identifying those infants with suspect or abnormal findings on the more detailed clinic evaluations. However, the effectiveness of the screeners' clinical impression ratings (based on observations made during administration of the DDST) in identifying infants with positive criterion results was encouraging. These findings suggest that, although the DDST's categorical results may be of limited value in screening biologically vulnerable infants, administration of the DDST may provide a useful framework for more systematically observing and documenting significant qualitative aspects of an infant's developmental status, particularly for the screener who is less experienced in neuromotor assessment. These observations need to be defined further, and validated.

Predictive Validity of the ???Movement Assessment of Infants???

Early identification of neuromotor deficits, cerebral palsy or other neurological handicaps, is a focus of concern for neurologists, pediatricians, and developmental therapists. Among infants at risk for developing these handicaps are those with low birthweight, idiopathic respiratory distress syndrome, and early central nervous system insults. The Movement Assessment of infants (MAI), a neuromotor assessment tool, was developed for the purpose of evaluating high-risk infants participating in the University of Washington's Neonatal Intensive Care Unit Followup Clinic. The predictive validity of the MAI was evaluated for 246 infants for whom assessments had been completed at four months and for whom at least one set of followup data was available at either one or two years of age. Correlations between the MAI total risk score and all five of the outcome measures at one and two years were highly significant. The clinical relevance of this study in the use of the MAI as an evaluation tool for identifying infants with neuromotor dysfunction is discussed.