If neurodevelopmental deficits are identified at an early stage in high-risk children, effective intervention will be practical. This prospective study examined the efficacy of a detailed neuromotor evaluation at age 3 months in predicting later neurological abnormalities in 60 infants who were depressed perinatally. Criteria for inclusion in the study included an umbilical cord blood pH of less than 7.1, base excess less than −10, a 5-minute Apgar score of 5 or below, and neonatal encephalopathy. The neuromotor score (NMS), determined on a 0-to-5 scale at ages 3 (NMS-3) and 12 (NMS-12) months, comprised a mental status evaluation, cranial nerve function, active and passive muscle tone and power in the trunk and extremities, and deep tendon and primitive reflexes. The mental component of the Bayley Scale of Infant Development was administered at 1 year of age to measure developmental outcome.
Neurological abnormalities were found in 52 percent of the 60 infants at age 12 months. They included all six infants with an NMS-3 of 5, and the NMS-3 was the most powerful predictor of the 1-year neurological outcome. In the lowest category (NMS-3 of 0), seven of eight infants were neurologically intact at 1 year of age. An NMS-3 of 4 or higher was 93 percent specific and 40 percent sensitive for later neurological abnormality, with a positive predictive value of 86 percent, but its negative predictive value was similar to that of the 5-minute Apgar score. Infants with abnormal NMS-3 and NMS-12 findings had had neonatal seizures more often than those whose abnormalities were transient or who had persistently normal neuromotor scores. Seizures occurred neonatally in 89 percent of infants with a mental development index (MDI) of less than 70, signifying significant developmental delay. A high NMS-3 correlated significantly with a low MDI at age 1 year. At the same time, 83 percent of infants with an MDI of 85 or higher had an NMS-3 of less than 3. It seems feasible to begin intervention as early as age 3 months using this neuromotor scoring system and, as a result, to gauge the effectiveness of new therapies and techniques in averting long-term neurodevelopmental abnormalities.
Pediatr Neurol 1999;21:788–793