Identifying premature infant at high and low risk for ... · 2Patricia Coker-Bolt, PhD OTR/L,...
Transcript of Identifying premature infant at high and low risk for ... · 2Patricia Coker-Bolt, PhD OTR/L,...
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Identifying premature infant at high and low risk for motor delays using motor performance testing and MRS Patricia Coker-Bolt, PhD OTR/L, FAOTA1; Kathryn Hope2, MPH; Viswanathan Ramakrishnan, PhD3; Truman Brown, PhD4; Denise Mulvihill, MD1, and Dorothea Jenkins, MD2
1Division of Occupational Therapy, 2Department of Pediatrics, 3Public Health Sciences, 4Radiology, Medical University of South Carolina, Charleston, SC
Background:
• Premature infants with normal cranial ultrasounds remain at risk for later
motor delays, which go undetected in early infancy.2
• Of the 12-16% of children with developmental delay, only half will be
identified by the time they enter kindergarten.1
• The Test of Infant Motor Performance (TIMP) is the current gold
standard infant motor assessment, but rarely used by pediatricians
during well-child visits due to lack of time and special training required.
• A short, standardized screening test administered to infants in the first
months of life would target early intervention to those most at risk.3
• In our previous work, Rasch partial credit model was used to analyze
and select 10 TIMP items with strongest correlation to motor ability at 12
months. New scales were then developed for more sensitive scoring of
these 10 items, comprising a novel screening tool, the Specific Test of
Early Infant Motor performance (STEP) (Figure 1).
Specific aims: Evaluate the robustness of a new, shortened, screening
assessment (STEP) through factor analysis of 10 motor items, and test the
STEP against current validated infant motor skills assessments and
outcome measures of development.
Design: A secondary analysis of an existing cohort of 22 preterm infants
(24-35 weeks gestation), with video recorded motor tests at 12 weeks and
12 months corrected gestational age (CGA). (Table 1)
Measures of Outcome:
• STEP scored from existing video recordings of TIMP at 12 weeks CGA.
• Test of Infant Motor Performance (TIMP) at term and 12 weeks CGA.
• Bayley III Scales of Infant and Toddler Development (Bayley III) at
12 months CGA. Bayley subscale scores ≤8 = low/below average 4,5.
• MRS: Siemens 3T: Single voxel [15 x 15 x 15 mm] in basal ganglia (BG) and frontal lobe white matter (WM) [echo PRESS sequence128 avg,
TR=2000ms, TE 30ms, 270ms].
• Data Analysis: Pearson’s correlational coefficient was used to relate
TIMP, Bayley and STEP scores. Exploratory factor analysis (EFA) was
used to identify latent constructs of STEP. Logistic regression, using EFA
scores, was performed to predict dichotomized Bayley outcome.
Sensitivity and specificity of EFA STEP scores were evaluated using
predictive outcomes versus actual outcomes. A drop-one-predict
evaluation was used to assess external validity.
ABSTRACT
DESIGN/ METHODS
RESULTS
Table 1. Patient Demographics Total Infants (N=22)
Sex 10 Females, 12 Males
Race 11 Caucasians, 11 African Americans
GA at Birth (mean ± SD) 29.6 ± 2.9 weeks
Birth weight (mean ± SD) 1259 ± 634 grams
Intracranial lesions 4 IVH (3 grade I, 1 grade II), 0 infarcts/PVL
Risk (TIMP at 12-weeks CGA) 9 High; 13 Low
Bayley Motor Outcome (N=19) 8 Average; 11 Low/Below Average
Figure 1. Representative schematic of STEP scale for “Prone Extension”
Head Control Upper
Extremity
Lower
Extremity
Pull to sit 0.89540 -0.23615 -0.06632
Prone extension 0.89496 -0.15936 -0.21346
Supine with no vision 0.84610 0.20399 -0.16812
Supine with vision 0.76003 -0.30853 0.16172
Standing 0.69165 -0.43411 0.23230
Supine sitting 0.76553 0.36989 0.00095
Grasp 0.24003 0.72577 -0.29594
Kicking 0.38154 0.48327 0.76373
Rolling with leg 0.65745 0.11327 -0.17037
% variance explained 68% 20% 12%
Table 2. Latent constructs of STEP using Exploratory Factor Analysis (EFA)
• STEP correlated with TIMP scores at
term (r=0.062, p=0.003), 12 weeks CGA
(r=0.79, p