Premature Infants Who Will Have Later Neurologic Problems Can Be Identified By Exam When They Are 18 Months Old

BUFFALO, N.Y. -- A study by a University at Buffalo researcher has shown that physicians can identify most of the prematurely born children among their patients who will experience sensory and/or motor deficits at 4 to 5 years of age by referring to the results of a standard neurologic examination administered routinely to premature babies at age 18 months.

The research showed that 89 percent of the children who tested in the low range at 18 months also tested low in a follow-up exam administered between the ages of 3 and 5.

Shelly J. Lane, Ph.D., UB assistant professor of occupational therapy and lead author on the study, said the findings indicate that the neurologic exam at 18 months can be used as a rationale for referring children to early intervention programs.

“These results indicate that among children born prematurely, 18-month neurologic status…is significantly predictive of sensorimotor deficits at four years,” Lane states.

The study was published in the May issue of American Journal of Occupational Therapy.

Many studies have shown that babies born prematurely are at risk for neurologic and developmental problems merely by virtue of their early birth. The 5-15 percent of these children with specific, identified deficits, such as cerebral palsy, hydrocephalus, or visual and hearing deficits, will likely receive early intervention and follow-up services.

It’s the children whose deficits are more subtle and less well-defined, but capable of causing learning and behavior problems by the time they reach school age, who often get no early intervention and follow-up services, Lane says. This is because no relationship has been firmly established between early test results and problems at school age, she adds.

In an effort to establish such a relationship, Lane’s team followed 30 children born prematurely who had been tested at 18 months -- 20 who were designated neurologically normal and 10 who were assessed as neurologically suspicious -- and tested them again between the ages of 3 and 5 years with a standard preschool assessment device.

Results showed that 8 of 9 children who tested neurologically suspicious at 18 months continued to show neurologic deficits as they reached preschool age. One child was unable to complete the test.

Lane points out that children born prematurely who have serious neurologic problems are identified early and receive a variety of special services, and that children who test firmly in the normal range at 18 months end up holding their own as a group.

"It’s the kids in the gray area that we’re concerned with in this study -- kids whose parents notice several areas in which the child is progressing differently than other kids," she says. "Physicians tend to take the global view in these cases, because the deficits often are subtle. They may advise parents that these children will grow out of their problems."

It would be in the best interest of the child if physicians would be sensitive to the concerns of parents, she says, and more willing to refer children who fall into a suspicious category for further evaluation. She recommends evaluating these children every 12-18 months so they can get help as soon as possible.

Addressing deficits early has several advantages, she says: The services have more impact, health professionals have more flexibility, and correcting problems before children enter school saves them from being stigmatized as developmentally needy.

"After five, you have to label children with a specific deficit for them to receive special help," Lane says. "If you get services early, you can perhaps circumvent the onset of problems when these children face the stress of school, and you don’t label the child at kindergarten."

Members of the research team, in addition to Lane, were Carla Soares Attanasio of Glenrose Hospital in Edmonton, Alberta, and Rebecca Farmer Huselid, Ph.D., of Hunter College, a doctoral fellow in the UB Center for the Study of Biobehavioral and Social Aspects of Health when the study was conducted.