Predicting Neurological Outcome in Very Low Birth Weight Infants Using Movement Assessment of Infants A Longitudinal Study

Abstract

Background and Purpose- With the advances in neonatal intensive care, the survival of Very low birth weight children has improved considerably in India. However, these children are at risk for significant motor impairment with poor developmental outcomes. The Movement Assessment of Infants is a widely used tool to assess motor dysfunction in high risk infants with good predictive validity for its 4 and 8 months profiles but has no validity studies for its preliminary 6-month profile. The predictive accuracy of Movement Assessment of Infants for high risk Indian infants has not been examined at any age. Hence the aim of this study was to evaluate the validity of the MAI to predict neuromotor outcome in very low birth weight infants at specific corrected ages of four, six and eight months during the first year of life. Methodology- This hospital based prospective observational study consecutively recruited 72 babies with birth weight and#8804;1500gms; admitted to Neonatal Intensive Care Unit of which 60 babies completed the one year follow up . The infants were evaluated at 4, 6 and 8 months of corrected age using the Movement Assessment of Infants scale and risk scores were recorded. A total score of and#8805;10 at 4 and 8 months evaluations was considered as risk for abnormal neurodevelopmental outcome and a score of and#8805; 6 was considered as risk for 6 month examination. This was followed by evaluation at 12 months using the gold standard Bayley Scale of Infant Development-II by a clinical psychologist. The Psychomotor Developmental Index and Mental Developmental Index scores were computed and a score of and#8804; 84 was considered as abnormal neurodevelopmental outcome. XII Results- The incidence of neurodevelopmental problems in VLBW infants at one year was 28.33% with 16.66% of them having significantly delayed development. The predictive validity of 4-month MAI relative to PDI and#8804; 84 was good with a sensitivity of 82.3%, specificity 74.4% and Negative predictive Value of 91.4%.The Positive predictive Value was lower (56%) with higher ra