Luke Carly, Benfer Katherine A, Mick-Ramsamy Leeann, Ware Robert S, Bosanquet Margot, Reid Natasha, Bos Arend F, Boyd Roslyn N
Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia.
Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia.
Dev Med Child Neurol. 2025 Sep 25. doi: 10.1111/dmcn.70003.
To determine the predictive relationship between evidence-based screening tools and neurodevelopmental outcomes in Australian First Nations infants.
This prospective cohort study invited First Nations families to participate in a culturally adapted early developmental screening programme. A total of 156 infants (55.1% male, mean gestational age = 33.6 weeks, SD = 4.6) were screened using the Prechtl's General Movements Assessment, with optimality scoring using the Motor Optimality Score-Revised (MOS-R) at 3 to 5 months and the Hammersmith Infant Neurological Examination (HINE) at 4 to 9 months. Participants completed 'baby movement (BM) checks' at two time points (BM1, 3-5 months corrected age; BM2, 4-9 months corrected age), with final movement and learning checks at 12 months corrected age. At 12 months corrected age, standardized motor, cognitive, and communication assessments, neurodisability-specific symptomology, or a diagnosis made by a paediatrician classified infants as developing typically ('on track') or (1) with a high chance of or confirmed cerebral palsy (CP) or (2) non-CP neurodevelopmental delay (NDD), including autism and fetal alcohol spectrum disorder (FASD). Predictive relationships were investigated using logistic regression and diagnostic statistics.
At 12 months, 127 of 147 (86%) eligible infants (n = 9 withdrawn or deceased) were classified as 'on track' (n = 55, 43%), NDD (n = 59, 47%), or CP (n = 13, 10%). MOS-R (≥ 14 weeks). The HINE distinguished infants as 'on track', CP, or NDD. Each 1-point decrease on both tools increased the odds of NDD (OR = 1.40, 95% confidence interval [CI] = 1.00-1.96; OR = 1.12, 95% CI = 1.05-1.21) and CP (OR = 1.47, 95% CI = 1.08-2.01; OR = 1.41, 95% CI = 1.21-1.65,). The MOS-R (cut-off of less than 23) and HINE (moderate to severely reduced) were best for identifying any NDD and CP (MOS-R: sensitivity = 84%, specificity = 38%; HINE: sensitivity = 64%, specificity = 63%). Combined trajectories across both tools were the strongest predictors of CP (sensitivity = 73%, specificity = 96%), autism (sensitivity = 59%, specificity = 95%), and FASD (sensitivity = 89%, specificity = 93%).
Evidence-based screening tools demonstrate promising transdiagnostic prediction of 'on-track' development and not only high chance of CP but also autism, FASD, and other NDDs.
确定循证筛查工具与澳大利亚原住民婴儿神经发育结局之间的预测关系。
这项前瞻性队列研究邀请原住民家庭参与一项经过文化调适的早期发育筛查项目。共156名婴儿（55.1%为男性，平均胎龄=33.6周，标准差=4.6）接受了普雷茨尔全身运动评估，在3至5个月时使用修订版运动最优性评分（MOS-R）进行最优性评分，在4至9个月时进行哈默史密斯婴儿神经学检查（HINE）。参与者在两个时间点（BM1，矫正年龄3至5个月；BM2，矫正年龄4至9个月）完成“婴儿运动（BM）检查”，在矫正年龄12个月时进行最终运动和学习检查。在矫正年龄12个月时，通过标准化运动、认知和沟通评估、神经残疾特异性症状或儿科医生做出的诊断，将婴儿分类为发育正常（“发育轨迹正常”）或（1）患脑瘫（CP）可能性高或确诊为脑瘫，或（2）非CP神经发育迟缓（NDD），包括自闭症和胎儿酒精谱系障碍（FASD）。使用逻辑回归和诊断统计方法研究预测关系。
在12个月时，147名合格婴儿中的127名（86%）（9名退出或死亡）被分类为“发育轨迹正常”（n=55，43%）、NDD（n=59，47%）或CP（n=13，10%）。MOS-R（≥14周）。HINE将婴儿区分为“发育轨迹正常”、CP或NDD。两种工具上每降低1分，NDD（比值比[OR]=1.40，95%置信区间[CI]=1.00-1.96；OR=1.12，95%CI=1.05-1.21）和CP（OR=1.47，95%CI=1.08-2.01；OR=1.41，95%CI=1.21-1.65）的几率增加。MOS-R（临界值小于23）和HINE（中度至严重降低）在识别任何NDD和CP方面效果最佳（MOS-R：敏感性=84%，特异性=38%；HINE：敏感性=64%，特异性=63%）。两种工具的综合轨迹是CP（敏感性=73%，特异性=96%）、自闭症（敏感性=59%，特异性=95%）和FASD（敏感性=89%，特异性=93%）的最强预测指标。
循证筛查工具对“发育轨迹正常”发育显示出有前景的跨诊断预测能力，不仅对患CP可能性高的情况，而且对自闭症、FASD和其他NDDs也有预测能力。
