The premie-neuro: opportunities and challenges for standardized neurologic assessment of the preterm infant

Adv Neonatal Care. 2012 Oct;12(5):310-7. doi: 10.1097/ANC.0b013e318265b3fa.

Abstract

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.

MeSH terms

  • Child Development
  • Gestational Age
  • Humans
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature / growth & development*
  • Intensive Care, Neonatal* / methods
  • Intensive Care, Neonatal* / standards
  • Male
  • Neonatal Screening* / methods
  • Neonatal Screening* / standards
  • Neurologic Examination* / methods
  • Neurologic Examination* / standards
  • Patient Discharge
  • Prospective Studies
  • Reference Values
  • Reproducibility of Results
  • Risk Assessment / methods
  • Risk Assessment / standards