Allied Health Women's and Families Service, Sunshine Coast Hospital and Health Service District, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia.
Faculty of Medicine, Child Health Research Centre, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
Dev Med Child Neurol. 2021 Apr;63(4):387-395. doi: 10.1111/dmcn.14730. Epub 2020 Nov 13.
This systematic review evaluates the accuracy of clinical tools used at a corrected age of 6 months or younger to predict motor and cognitive delay (not cerebral palsy) at 24 months' corrected age, in infants born very preterm.
Six databases were searched. Quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. Predictive analysis included calculation of sensitivity and specificity, inspection of summary receiver operating characteristics curves, and bivariate meta-analysis.
Six assessments were identified in 10 studies of 992 infants. Overall prevalence of motor delay was 13.8% and cognitive delay was 11.7%. Methodological quality was variable for patient selection, reference standard, flow, and timing. All studies had a low risk of bias for the index test. General Movement Assessment (GMA) predicted motor and cognitive outcomes with good accuracy for mild, moderate, and severe delays (fidgety age: pooled diagnostic odds ratio=12.3 [5.9-29.8]; hierarchical summary receiver operating characteristics curve=0.733). The Hammersmith Infant Neurological Examination (HINE) demonstrated excellent predictive accuracy for severe motor delay (3mo and 6mo; sensitivity 93% [68-100%], specificity 100% [96-100%]) but showed limited ability to predict milder delays.
In the population of infants born very preterm, few assessment tools used at 6 months or younger corrected age have proven predictive accuracy for cognitive and motor delay at 24 months' corrected age. Only the GMA and HINE demonstrated useful predictive validity.
General movements have predictive validity for both motor and cognitive dysfunction in infants born very preterm. The Hammersmith Infant Neurological Examination showed the highest predictive accuracy for severe motor delay. The General Movement Assessment was the best tool to predict mild-to-moderate motor and cognitive delays.
本系统评价评估了在纠正年龄为 6 个月或更小的早产儿中使用临床工具预测校正年龄为 24 个月时运动和认知延迟（非脑瘫）的准确性。
检索了 6 个数据库。使用诊断准确性研究质量评估工具评估质量。预测分析包括计算敏感性和特异性、检查汇总受试者工作特征曲线和双变量荟萃分析。
在 10 项研究的 992 名婴儿中确定了 6 项评估。运动延迟的总体患病率为 13.8%，认知延迟为 11.7%。患者选择、参考标准、流程和时间方面的方法学质量各不相同。所有研究对指标检测均具有低偏倚风险。全身运动评估（GMA）对轻度、中度和重度延迟的运动和认知结果具有良好的准确性（不安年龄：汇总诊断比值比=12.3[5.9-29.8]；层次汇总受试者工作特征曲线=0.733）。汉密尔顿婴儿神经检查（HINE）对严重运动延迟（3 个月和 6 个月）具有出色的预测准确性（敏感性 93%[68-100%]，特异性 100%[96-100%]），但对轻度延迟的预测能力有限。
在出生极早产儿的人群中，很少有在 6 个月或更小的校正年龄使用的评估工具能够预测 24 个月校正年龄的认知和运动延迟。只有 GMA 和 HINE 显示出有用的预测有效性。
全身运动对极早产儿的运动和认知功能障碍均具有预测价值。汉密尔顿婴儿神经检查对严重运动延迟的预测准确性最高。全身运动评估是预测轻度至中度运动和认知延迟的最佳工具。
