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Can Neurobehavioral Examination Predict the Presence of Cerebral Injury in the Very Low Birth Weight Infant?

WOODWARD, LIANNE J. Ph.D.1; MOGRIDGE, NINA R.N., Dipl. N.E.2; WELLS, SCOTT W. MBChB, FRANZCR3; INDER, TERRIE E. M.D.4

Journal of Developmental & Behavioral Pediatrics: October 2004 - Volume 25 - Issue 5 - p 326-334
Original Articles

ABSTRACT. This study examined in a regional cohort of 66 term age very low birth weight infants, the relationship between qualitative magnetic resonance imaging (MRI) measures of cerebral white and gray matter abnormalities and infant neurobehavioral functioning assessed by structured neurological examination. The diagnostic utility of the Dubowitz neonatal neurological examination in identifying children with severe cerebral abnormalities was also evaluated. Examination results revealed the presence of high rates of neurological abnormality, with 60% of infants scoring in the suboptimal range relative to infants born full term. Linear associations were found between the severity of structural cerebral abnormality on MRI and the quality of clinically rated infant neurobehavioral functioning, with increasing abnormalities being significantly associated with poorer neurological functioning. In particular, white matter abnormalities were significantly associated with lower mean tone and tone pattern scores and a tendency toward lower mean reflex scores. Gray matter abnormalities were significantly associated with lower tone and tone pattern scores and a tendency toward lower spontaneous movements and orientation/behavior scores. Finally, the Dubowitz Neonatal Neurological Examination was found to have relatively good sensitivity (88%; negative predictive value, 92%) but poor specificity (46%; positive predictive value, 34%) for identifying children with significant MRI abnormalities. Implications of these findings for the neurological evaluation of the very low birth weight infant are discussed.

1University of Canterbury and Christchurch School of Medicine, Christchurch, New Zealand

2Christchurch School of Medicine, Christchurch, New Zealand

3Christchurch Radiology Group, Christchurch, New Zealand

4Murdoch Children's Research Institute, Howard Florey Institute, University of Melbourne, Melbourne, Australia

Received March 2003; accepted March 2004.

Address for reprints: Lianne Woodward, Ph.D., Child Development Research Group, Department of Education, University of Canterbury, Private Bag 4800, Christchurch, New Zealand; e-mail: lianne.woodward@canterbury.ac.nz.

© 2004 Lippincott Williams & Wilkins, Inc.