背景:早期发现发育问题很重要,因为它允许早期干预。以前的研究,在高危婴儿中,在标准化婴儿神经发育评估(SINDA)中发现非典型评分对晚期神经发育障碍的高预测值(即,脑瘫,智力残疾)。
目的:本研究探讨了SINDA预测4-5年发育迟缓风险的预测价值。
方法:队列研究。
方法:786名荷兰低危儿童(367名男孩;中位胎龄:40(27-42)周;平均出生体重:3455(SD577)克)。
方法:在2-12个月时评估SINDA,在4-5年时使用年龄和阶段问卷(ASQ)评估发育迟缓的风险。确定了五个ASQ域的SINDA预测值,并确定了有明显(所有ASQ域偏离)和任何(一个或多个ASQ域偏离)发育延迟风险的儿童的ASQ总分。
结果:存在一个非典型SINDA量表评分显示出低至中度敏感性(12-88%,取决于所涉及的SINDA量表和ASQ域),中等至高特异性(66-94%),低阳性预测值(PPV;3-16%),和高阴性预测值(NPV;95-100%)的儿童处于明显和任何发育的风险。多个非典型SINDA量表得分的存在对ASQ域的预测略好(敏感性=11-62%,特异性=90-98%,PPVs=6-30%,和NPV=95-100%)。
结论:在低风险婴儿中,SINDA的预测价值较低,用于检测4-5岁有明显和任何发育迟缓风险的儿童,正如低敏感度所反映的那样。解释之一是低风险人群中发育迟缓的患病率相对较低。这可能会对SINDA在一般医疗机构(例如儿童健康诊所)中的应用产生影响。但是需要进一步的研究才能得出这一结论。
BACKGROUND: Early detection of developmental problems is important as it allows for early intervention. Previous studies, in high-risk infants, found high predictive values of atypical scores on the Standardized Infant NeuroDevelopmental Assessment (SINDA) for later neurodevelopmental disorders (i.e., cerebral palsy, intellectual disability).
OBJECTIVE: The present study explored SINDA\'s predictive values to identify risk of developmental delay at 4-5 years.
METHODS: Cohort study.
METHODS: 786 low-risk Dutch children (367 boys; median gestational age: 40 (27-42) weeks; mean birth weight: 3455 (SD 577) grams).
METHODS: The SINDA was assessed at 2-12 months and risk of developmental delay was assessed using the Ages and Stages Questionnaire (ASQ) at 4-5 years. SINDA\'s predictive values were determined for five ASQ domains and the total ASQ score for children at risk of marked (all ASQ domains deviant) and any (one or more ASQ domains deviant) developmental delay.
RESULTS: Presence of one atypical SINDA scale score showed low to moderate sensitivities (12-88 %, depending on the SINDA scale and ASQ domain involved), moderate to high specificities (66-94 %), low positive predictive values (PPVs; 3-16 %), and high negative predictive values (NPVs; 95-100 %) for children at risk of marked and any developmental. Presence of multiple atypical SINDA scale scores predicted deviant ASQ domains slightly better (sensitivities = 11-62 %, specificities = 90-98 %, PPVs = 6-30 %, and NPVs = 95-100 %).
CONCLUSIONS: In low-risk infants, SINDA\'s predictive value is low for detecting children at risk of marked and any developmental delay at 4-5 years, as reflected by the low sensitivities. One of the explanations is the relatively low prevalence of developmental delay in low-risk populations. This might have consequences for the application of the SINDA in general healthcare settings (e.g. child health clinics), but further studies are needed to draw this conclusion.