Predicting developmental outcomes in very preterm infants: validity of a neonatal neurobehavioral assessment

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Aim:  This study explored inter‐rater reliability, discriminative, construct and predictive validity of the Neurobehavioral Assessment of the Preterm Infant (NAPI) in a gestational‐age‐based cohort.

Methods:  The NAPI was conducted at 35 weeks post‐menstrual age for 170 infants born <32 weeks. Cognitive and motor development was assessed at 2 years using the Mental Development Index (MDI) and Psychomotor Development Index (PDI) of Bayley Scales of Infant Development‐II for 159 infants.

Results:  Only NAPI motor and irritability scores were significantly different between very (29–3 w) and extremely preterm (<28 w) infants. Results regarding construct validity were variable: there were weak correlations between NAPI motor scores and gestational age (r = −0.23; p = 0.003), days in NICU (r = −0.24; p = 0.001); NAPI alertness scores and days in NICU (r = −0.16; p = 0.037); and NAPI irritability scores and gestational age (r = 0.21; p = 0.006). There were no significant associations with other markers of adverse outcome. Only NAPI irritability scores were correlated with MDI scores (r = −0.16; p = 0.040) but accounted for little additional variance after adjustment for neonatal factors (ΔR2 = 0.035; p = 0.012).

Conclusion:  We found little evidence of the utility of the NAPI as a measure of short‐term neurobehavioural function or for predicting neurodevelopmental outcomes in very preterm infants. It may have greater predictive power when used serially to detect delayed neurobehavioural maturation.

Document Type: Research Article


Affiliations: 1:  Department of Health Sciences, University of Leicester, Leicester, UK 2:  School of Community Health Sciences, University of Nottingham, Nottingham, UK 3:  Neonatal Intensive Care Unit, Southmead Hospital, Bristol, UK 4:  Research Department of Academic Neonatology, Institute for Women’s Health, University College London, London, UK 5:  School of Clinical Sciences, University of Bristol, Bristol, UK

Publication date: July 1, 2012

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