Time table and screening methods on developmental follow-ups in at risk infants vary in different countries. Some NICUs use objective screeners and others subjective tools. Is the ASQ appropriate for high risk follow-ups?
THE ASQ-SE is good but must be adjusted to take into account a premature infant's gestational age. I find that the Score for Neonatal Acute Physiology (SNAP-II and SNAPPE with perinatal extension by Richardson et al., 2001) are useful for the clinician to take into account when interpreting developmental screeners in combination. And then the N-BAS (Brazelton) research version is also a useful measure observationally and to help the parent discover the baby and support their relationship under stress-- See Bruschweiler-Stern's work). Other more specific measures have been applied to look at social-emotional development by parental report. See papers by the Lausanne group: Müller-Nix, Borghini, Pierrehumbert and by the Stanford group, Richard Shaw et al. for example, as well as of course the work of Heidi Als.
I hope that this helps!
Best wishes,
Dan
I wrote ASQ-SE but meant ASQ in general without forgetting to include the Social-emotional module. In addition, I meant also add that the Bayley Scales for observation are the most important measure we use once the infant is old enough.
A Denver -II in the first 6-12 months and a Bayley III at 18-36 months are standard in literature. Remember that the Bayley III underestimates developmental delay by about 10 points (see paper by Anderson et al)
Personally as Neonatologist, I use Bayeley infants neurodevelopmental screener (BINS) 1995. it is really suitable for busy clinic as takes only 10 min, and extremely reliable test and easy to perform
The most important thing is to learn and master any of the available standard tests in the market to ensure that all at high-risk neonates received proper neurodevelopmental evaluation
We use the Rapid Neonatal Neurobehavior Assessment (RNNA), which has reliability and both concurrent (eg, CNS injury) and predictive (eg, BSID at older ages) validity. It was developed for fragile, high-medical risk NICU infants, takes less than 10 min to administer (for a trained/experienced person), and is non-stressful. We administer the RNNA just prior to NICU discharge (33-41 wks PCA) and then at 43-45 wks PCA (1 month PTA). It consists of sensory (visual and auditory) items, and emphasizes active (rather than passive) motor behavior. Each item is scored and contributes to qualitative judgments (1, 2, or 3) of performance on different categories of behavior not maturity, which also has utility for guiding early intervention.
We are using the ASQ-III at corrected age up to 3 years old in conjunction to the ASQ-SE for the behavioral part. Our team completed a research looking at what is the most useful for helping the MDs to make decision in regards of developmental resources to promote best development route and we found that the ASQ-III in association with the neurological exam is sufficient to make over 90% of the decision. The Bayely-III changed only 7% of our decision in only milder cases of development. So now we are doing ASQ-III for all or our follow-up population and the Bayley-III for those who are born less than 26 weeks GA. The ASQ-III, being cheaper ans easier to admininster, offer also the advantage to screen developement in multiple spheres. I agree wiht Badr Sobaih above comments as well about the importance of mastering any one of the available standard tests.
our team of PT and SLT use their own tools across the city that is adapted from Bayley's screener
I use Bayley's III at 2 years corrected, but it is very important to fill in with the parents the behaviour observatory sheet as it tells you a lot about the potential educational difficulties these children might have.
I used Schedule for Growing Skills as follow-up tool for the over 2 with some problems as it is quick and show you the trend of improvement
Judith - OMG! How young are your CNS Injury pts.? And what counts as a CNS? Some of the ages you are citing are younger than I've had kids d/c'd from the NICU (hence my question).
Melinda
Forgive me! I ought to have said that I prefer using the Bayley-III (has a screener and a full exam). Also, I like to throw in a social-emotional measure. I like the Greenspan Social-Emotional measure. Parts of it are in the Bayley-III, but not all parents can tolerate all of the questions I'd like to ask them. In addition, because the Greenspan can be gotten separately, I can send one to a nursery and check with nurses, teachers, etc. and see if what I see; what parents see; and what others see all match or not.
There are 2 other major scales I can cite that many in the U.S. use - one is by T. Berry Brazelton, M.D.. The other is by Heidelise Als, Ph.D. (Both either were or still are at Children's Hospital - Boston.)
In your practice, What's the time table during the first 3 years of life for bayley screening or other scales?
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