Hammersmith Infant Neurological Examination and long?term cognitive outcome in children born very preterm

To study the association between Hammersmith Infant Neurological Examination (HINE) at age 2 years and neurocognition 11 in children born very preterm. We hypothesized that HINE would be associated with neurocognition, is, neurological, motor, cognitive outcomes years. A total of 174 (mean gestational 29.0wks, SD 2.7; minimum 23.0, maximum 35.9; 95 [55%] males, 79 [45%] females) preterm (birthweight ?1500g/gestational <32wks), were included a prospective cohort recruited from 2001 to 2006 Turku, Finland. The was performed years’ corrected age. Neurocognition assessed Touwen neurological examination, Movement Assessment Battery for Children, Second Edition (MABC-2), full-scale IQ (Wechsler Intelligence Scale Fourth Edition). global score results examination (odds ratio [OR]=0.9, 95% confidence interval [CI] 0.8–0.9, p=0.001), MABC-2 (?=1.4, CI 0.7–2.2, p<0.001), (?=1.2, 0.8–1.7, even when adjusted. When cerebral palsy (CP) excluded, still (unadjusted ?=1.2, 0.3–2.1, p=0.01). higher better general intelligence without CP. may useful tool detect risk later impairment. Estudiar la asociación entre el examen neurológico infantil de los años y neurocognición en niños nacidos muy prematuros. Presumimos que estaría asociada con neurocognición, es decir, resultados neurológicos, motores cognitivos años. Un (edad gestacional media 29,0 semanas, DE 2,7; mínimo 23,0, máximo 35,9; varones, mujeres) prematuros (peso al nacer ? 1500 g / edad <32 semanas), se incluyeron una cohorte prospectiva reclutada Finlandia. El realizó corregida. La evaluó Touwen, batería evaluación del movimiento para niños, segunda edición (MABC-2) coeficiente intelectual gran escala (escala inteligencia Wechsler cuarta edición). puntuación asoció (razón posibilidades [OR] = 0,9; intervalo confianza [IC] 95%: 0,8-0,9, p 0,001), (? 1,4, % 0,7–2,2, <0,001) completa 1,2, 0,8–1,7, <0,001), incluso cuando ajusta. Cuando excluyó parálisis (PC), todavía no ajustado IC 0,3–2,1, 0,01). Una más alta mejor sin cerebral. puede ser herramienta útil detectar riesgo deterioro cognitivo posterior. Estudar associação o Exame Neurológico na idade anos e neurocognição em crianças nascidas muito prematuras. Hipotetizamos aos seria associada com neurocognição, ou seja, os anos. Um (média DP do sexo masculino, feminino) prematuras ao nascimento ?1.500g/idade <32sem), foram incluídas um estudo coorte recrutada Finlândia. foi aplicadas corrigida. Neurocognição avaliada exame Towen, Bateria avaliação movimento QI (Escala inteligência crianças, quarta edição). O escore da associado (taxa risco [TR]=0,9, confiança 0,8–0,9, p=0,001), (?=1,4, p<0,001), (?=1,2, mesmo quando ajustado. Quando as paralisia (PC) excluídas, ainda não ajustado=1,2, IC95% p=0,01). maior melhor geral sem PC. pode uma deficiência cognitiva mais tarde. incidence is decreasing1, whereas other neurodevelopmental impairments, such minor dysfunction (MND) developmental coordination disorder (DCD), are prevalent compared their peers.3, 4 Both MND DCD commonly co-occur difficulties, problems learning, behaviour, attention;5-7 this underlines importance recognizing these conditions absence structured newborn has been shown an efficient predict early outcome.8, 9 simple standardized method assessing 3 24 months age.10 It strong predictive validity CP before 5 months, particularly combined brain magnetic resonance imaging (MRI).8 Although can usually diagnosed by years,8, scales might underestimate rate non-CP impairments later, more specific assessments.1 Children also different levels impairment.1, 11-13 assessment term-equivalent associate development preterm.14 our knowledge, studies have conducted on childhood neurocognitive middle-school Our aim hypothesis In addition, we expected outcome concurrent outcome. This regional part multidisciplinary PIPARI (The Development Functioning Very Low Birth Weight Infants Infancy School Age) infants preterm.15 Participants January December Finnish- or Swedish-speaking families Turku University Hospital, From 2003, inclusion criteria birthweight equal less than grams birth (<37wks gestation). 2004, extended all 32 weeks irrespective birthweight. Exclusion severe congenital anomalies syndromes affecting development. flow chart showing participant selection Figure S1 (online supporting information). ethics review committee Hospital District South-West Finland approved protocol 2000 2012. Written informed consent provided parents children. experienced physician physiotherapists using HINE.10 sequential Neonatal during neonatal period, but not unless there high clinical suspicion consists three sections: (1) examination; (2) milestones; (3) behaviour. first section includes 26 items evaluate five subsections: cranial nerve function; posture; movements; tone; reflexes. second eight describe milestones third behaviour assessment. Each item scored individually scores summed up calculate subsection then (minimum 0, 78). study, analysed continuous variable. If diagnosis CP, it confirmed after systematic follow-up child neurologist. classify severity Gross Motor Function Classification System (GMFCS) used.16 examination.6 one physicians except ophthalmological part, which ophthalmologist comprehensive domains: posture muscle reflexes; fine manipulation; involuntary balance; sensory function. All tests video recorded; case any uncertainty regarding examinations, videos reassessed together examinations classified according classification set out Hadders-Algra6 computerized scoring. result considered neurologically typical if had abnormal domains; two dysfunctional domains, regarded MND. For complex MND, domains dysfunctional. who having condition within range, unlike done highlight clinically important features MND.17 evaluated (MABC-2)18, 19 same examination. subscales: manual dexterity; aiming catching; balance. raw subscales converted into standard centile test band (11–16y) norms 11-year-old greater fifth indicated motor centile, interfered activities daily living, denoted DCD.19 Developmental Coordination Disorder Questionnaire 2007 used assess how living. questionnaire published elsewhere.20 Cognitive (WISC-IV), Finnish translation.21, 22 Swedish child’s native language. assessments Finnish-speaking psychologists native-speaking psychologist. General measured consisted four indexes: verbal comprehension; perceptual reasoning; working memory; processing speed. Based manual,21, 70 (?2SD) Differences background characteristics (gestational birthweight) participating withdrew studied independent samples t-test (Table 1). categorical characteristics, ?2 Fisher’s exact used, appropriate. 11-year (typical DCD, IQ?70 IQ<70) Mann–Whitney U (Tables 2–4). Associations variables (MABC-2, IQ, indexes WISC-IV) linear regression analysis. variable MND) logistic IQ) regression. analyses adjusted sex, MRI findings term, paternal education, z-score since previously found cognition cohort.12 Goodness fit reported Akaike information criterion, where smaller-is-better form 5). Residuals checked justify Possible multicollinearity checked; correlation coefficient 0.8 and/or tolerance value 0.1 Phi Cramer’s V sign multicollinearity. Statistical analysis SPSS v27.0 (IBM Corp., Armonk, NY, USA). two-tailed p<0.05 statistically significant. examined Table 1. median 74.1 38.0, 78.0). Nine (5%) 56.0 74.0) (minimum, maximum) 15.00 (12.0, 15.0) function, 9.5 (7.5, 16.0) posture, 19.5 (10.0, 24.0) tone, 3.0 (0.0, 6.0) movements, 9.0 (4.5, 14.0) Of GMFCS level I, II, IV. cases. 166 (95%) children, 127 (77%) including 63 (38%) 64 (39%) 31 (19%) successfully examined. decreased included; did remain. presents values 140 (84%) development, 18 (11%) centiles 3. (100%) WISC-IV 165 150 (91%) 70. (44%) mean 6. 6 shows associations improved 1.2 points increased point p<0.001). scatter plot At years, (?=14.1, 8.5–19.8, p<0.001); excluded (?=10.6, 4.7–16.4, lower (81.3 vs 91.9, reasoning (86.1 95.6, p=0.002), memory (82.1 96.2, however, difference significant comprehension (88.5 91.7, p=0.3) speed (90.0 96.3, p=0.06). Severe impairment common range (26% 3%, showed show 1 point, subsequent points. significantly intelligence, comprehension, reasoning, z-score. abilities, evident excluded. seems tap aspects line Romeo et al.,23, 3, 6, 9, 12 provides about adverse consistent previous data.7, 17 prevalence 11-year-olds 26%. contrast, national register 2.5% 7-year-olds preterm.13 only relevance its detection launches targeted support services. These experience, could predicted based single However, reliable identification CP8 correlates findings.25 supported recent Caesar al.,26 although sensitivity specificity prediction discriminative mild-to-moderate impairments. Thus, reasonable excluded.27 term because negative normal pathologies 90.3% positive major 31.5%.28 According Hadders-Algra, likely structural deficit borderline CP.17 Despite emergence possible alterations structure function behind impairments,6, 29 connection well known pathology. subscale data exhibit challenges postural control neurodevelopment, seem repertoire mechanisms.30 Compared disability challenging. suboptimal increase delay years.14, Early involves combination neuroimaging assessments. primarily confirm correctly. Bayley Scales Development, Edition, described Munck al.32 parental questionnaire, example, Parent Report Children’s Abilities-Revised,33 offer alternative identify settings available. strength longitudinal study. Retention reasonably high. trained specialists. latest full versions instead abbreviated measures. Regarding WISC-IV, up-to-date some limitations. single-centre relatively small subgroup outcomes, limit generalizability findings. compare peers group. Another potential limitation repeatedly suggested recommendations.5 most guidelines collection numbers moderate, conclusion, helped Interestingly, HINE, status age, finding should explored future studies. emphasize recognition initiation services due time optimize neurocognition. thank Mari Koivisto statistical support. phases grants Arvo Lea Ylppö Foundation, Emil Aaltonen Medical Finska Läkaresällskapet, Yrjö Jahnsson Foundation Paediatric Research. Data available request authors. Please note: publisher responsible content functionality supplied Any queries (other missing content) directed corresponding author article.