背景:发育监测,在全球范围内例行进行,对于及时识别有发育迟缓风险的儿童至关重要。通常通过评估适合年龄的里程碑成就并在健康监督访问期间应用临床判断来执行。与开发筛选和评估工具不同,监测通常缺乏标准化的定量措施,因此,它的解释往往是定性的和主观的。
目的:在此,我们提出了一种新的方法,用于将发育监测评估汇总为一个统一的评分,以连贯地描述和监测儿童发育.我们描述了计算分数的程序,并证明了其有效捕获已知人群水平关联的能力。此外,我们发现该评分可用于描述纵向发育模式,这可能有助于跟踪和分类儿童的发育轨迹。
方法:我们描述了发展监测评分(DSS),一个简单易用的工具,根据最近推出的以色列发育监测计划,量化在达到发育里程碑时失败的年龄依赖性严重程度。我们使用全国范围内的超过100万以色列儿童从出生到36个月大的队列来评估DSS,在2014年7月1日至2021年9月1日之间进行评估。我们测量了该评分对发育迟缓与母子特征之间已知关联的能力。此外,我们在连续访问中计算了一系列DSS来描述儿童的纵向发育,并应用聚类分析来识别这些发育轨迹的不同模式。
结果:分析的队列包括1,130,005名儿童。DSS对队列亚群的评估,按已知的发育迟缓危险因素分层,揭示了发育迟缓与孩子和母亲特征之间的预期关系,包括人口统计和产科相关变量。平均而言,与足月儿童相比,早产儿的得分更差,与女童相比,男童的得分更差,母亲教育水平较低的情况相应地更糟。294,000名儿童获得了连续6次访问的得分轨迹。这些轨迹的聚类揭示了与临床经验一致的3种主要类型的发育模式:成功达到里程碑的儿童,最初倾向于失败但随着时间的推移而进步的孩子,和孩子的失败往往会随着时间的推移而增加。
结论:建议的分数可以直接以其基本形式计算,并且可以很容易地以更精细的形式实现为基于Web的工具。它强调了发育迟缓与母亲和孩子的特征之间的已知和新颖的关系,证明其对监测和研究的潜在有用性。此外,它可以监测儿童的发展轨迹并对其进行表征。需要未来的工作来校准相对于其他筛查工具的分数,在全球范围内验证它,并将其整合到发育监测的临床工作流程中。
Developmental surveillance, conducted routinely worldwide, is fundamental for timely identification of children at risk of developmental delays. It is typically executed by assessing age-appropriate milestone attainment and applying clinical judgment during health supervision visits. Unlike developmental screening and evaluation tools, surveillance typically lacks standardized quantitative measures, and consequently, its interpretation is often qualitative and subjective.
Herein, we suggested a novel method for aggregating developmental surveillance assessments into a single score that coherently depicts and monitors child development. We described the procedure for calculating the score and demonstrated its ability to effectively capture known population-level associations. Additionally, we showed that the score can be used to describe longitudinal patterns of development that may facilitate tracking and classifying developmental trajectories of children.
We described the Developmental Surveillance Score (DSS), a simple-to-use tool that quantifies the age-dependent severity level of a failure at attaining developmental milestones based on the recently introduced Israeli developmental surveillance program. We evaluated the DSS using a nationwide cohort of >1 million Israeli children from birth to 36 months of age, assessed between July 1, 2014, and September 1, 2021. We measured the score\'s ability to capture known associations between developmental delays and characteristics of the mother and child. Additionally, we computed series of the DSS in consecutive visits to describe a child\'s longitudinal development and applied cluster analysis to identify distinct patterns of these developmental trajectories.
The analyzed cohort included 1,130,005 children. The evaluation of the DSS on subpopulations of the cohort, stratified by known risk factors of developmental delays, revealed expected relations between developmental delay and characteristics of the child and mother, including demographics and obstetrics-related variables. On average, the score was worse for preterm children compared to full-term children and for male children compared to female children, and it was correspondingly worse for lower levels of maternal education. The trajectories of scores in 6 consecutive visits were available for 294,000 children. The clustering of these trajectories revealed 3 main types of developmental patterns that are consistent with clinical experience: children who successfully attain milestones, children who initially tend to fail but improve over time, and children whose failures tend to increase over time.
The suggested score is straightforward to compute in its basic form and can be easily implemented as a web-based tool in its more elaborate form. It highlights known and novel relations between developmental delay and characteristics of the mother and child, demonstrating its potential usefulness for surveillance and research. Additionally, it can monitor the developmental trajectory of a child and characterize it. Future work is needed to calibrate the score vis-a-vis other screening tools, validate it worldwide, and integrate it into the clinical workflow of developmental surveillance.