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The Premie-Neuro: Opportunities and Challenges for Standardized Neurologic Assessment of the Preterm Infant

Gagnon, Kendra PhD, PT; Cannon, Susan MS, PT; Weatherstone, Kathleen B. MD

doi: 10.1097/ANC.0b013e318265b3fa
Original Research

Purpose: To determine the interrater and test-retest reliabilities and construct validity of the Premie-Neuro, a standardized neurologic assessment tool for preterm infants.

Subjects: Thirty-four preterm infants (mean gestational age at birth 29 ± 3.7 weeks, mean birth weight 1343.2 ± 696.3 g) participated in the study.

Design: A prospective repeated-measures design was used to assess the reliability and validity of the Premie-Neuro.

Methods: The Premie-Neuro was administered twice on consecutive days and then weekly through 37-weeks postmenstrual age or hospital discharge. At discharge, infants' medical histories were reviewed and a Neurobiologic Risk Score (NBRS) was used to determine risk for poor neurodevelopmental outcomes.

Main Outcome Measure: Premie-Neuro raw scores and classifications were analyzed to determine the tool's reliability. Construct validity was measured by determining whether the Premie-Neuro could discriminate between infants identified as high-risk or low-risk for neurodevelopmental delays by using a NBRS of 5 as the cutoff for high- and low-risk infants.

Results: The intraclass correlation coefficients for interrater and test-retest reliability varied from 0.391 to 0.556 and from 0.493 to 0.592, respectively. Analysis of variance revealed that the Premie-Neuro raw scores for infants with NBRS > 5 were significantly worse than those for infants with NBRS < 5 (P = .000-.010).

Conclusions: The Premie-Neuro is a valid assessment tool for discriminating between preterm infants at high and low risk for neurodevelopmental delay. Interrater reliability of the Premie-Neuro was poor, and test-retest reliability of the Premie-Neuro was fair to moderate. The Premie-Neuro may be acceptable for assessing groups of infants, but there is no evidence that reliability is sufficient for clinical decision-making for individual infants. More research needs to be done to improve the reliability of the Premie-Neuro and assess other facets of the Premie-Neuro's reliability.

Department of Physical Therapy and Rehabilitation Science (Dr Gagnon) and Center for Child Health and Development (Ms Cannon), University of Kansas Medical Center, Kansas City; and Neonatal Intensive Care Services, Sunflower Neonatology Associates, Overland Park Regional Medical Center, Kansas (Dr Weatherstone).

Correspondence: Kendra Gagnon, PhD, PT, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow, Kansas City, KS 66160 (

This study was completed in partial fulfillment for the degree of Doctor of Philosophy in Rehabilitation Science at the University of Kansas Medical Center for the first author.

Subject recruitment, data collection, and analysis for this study were conducted at the University of Kansas Medical Center, Kansas City, and Overland Park Regional Medical Center, Overland Park, Kansas.

The authors thank Donna Daily, MD, for allowing the use of the Premie-Neuro for this study. They also thank Byron Gajewski, PhD, for consulting with their research team in planning, carrying out, and interpreting the statistical analyses in this study.

The authors declare no conflict of interest.

© 2012 National Association of Neonatal Nurses