EARLY ASSESSMENT AND NEURODEVELOPMENTAL OUTCOME IN VERY-LOW-BIRTH-WEIGHT INFANTS - IMPLICATIONS FOR PEDIATRIC PRACTICE

To determine which assessments are useful, at what age, in order to identify handicaps in very low-birth-weight infants, neonatal cerebral ultrasound findings, neurological examinations and the mental scale of the Bayley Infant Scales of Development at 1 and 2 years of age were examined in relation to neurodevelopmental outcome at 3.6 years of age in a cohort of 79 high-risk very low-birth-weight infants. At 3.6 years of age, a minor handicap was found in 9 (11%) and a major handicap in 4 (5%) children. Cerebral palsy was found in 9 (11%) children at 3.6 years of age and could only be diagnosed reliably at 2 years of age. For short-term follow-up, as feedback to the neonatalogist, the positive predictive value of intraparenchymal damage, as detected by neonatal cerebral ultrasound, was greater than the positive predictive value of a definitely abnormal neurological examination at 1 year of age. Visual handicaps (n = 4, 5%) and severe hearing deficits (n = 1, 1%) were all detected in the first year of life. A mental handicap was found in 7 (9%) children. It was impossible to predict mental handicaps for the individual child. Only 35% of the children with a mental delay at 2 years of age had a mental handicap at 3.6 years of age, whereas 35% had a normal cognitive outcome. Pediatricians therefore should be cautious in the interpretation of developmental test results in infancy. Long-term follow-up is essential for the child and its parents.