Marilee Allen M.D., Professor of Pediatrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, CMSC 210 Baltimore, MD 21287 mcallen@jhmi.edu
Abstract
Despite advances in neuroimaging techniques that visualize central nervous system (CNS) injury, it is impossible to predict individual outcome for preterm infants discharged from a Neonatal Intensive Care Unit (NICU). Neuroimaging cannot replace clinical skills needed to assess the rate and quality of a child's development in order to diagnose disability (at the earliest, 1 2 years). While perinatal risk factors help identify infants at risk for neurodevelopmental disability, definitive diagnosis requires examination and use of child based measures of cognition, language, motor abilities and adaptive function. We have extended our previous work on motor and language milestones as predictors of preterm outcome by designing a 2 part measure of CNS function at the earliest possible extrauterine age. We perform serial neurodevelopmental examinations on preterm infants in a NICU and score them by quantifying both degree of abnormality (Abnormality Score) and rate of neuromaturation (Maturity Score). Requiring expertise but not technology, these exams can be useful wherever trained clinicians encounter preterm infants. Our measures of early CNS function can be used to evaluate how preterm development is influenced by CNS injury, illness and recovery and have the exciting potential to provide insight into causes of and responses to CNS injury in preterm infants. This project proposes to 1) establish norms for CNS function and neuromaturation prior to term, 2) determine how infants with intrauterine growth restriction, perinatal intraventricular hemorrhage and neonatal chronic lung disease differ from established norms for early CNS function, and 3) evaluate the efficacy of these measures in determining delay and predicting neurodevelopmental disability and functional outcome at 18 months. This endeavor contributes substantially to a systematic approach to clinical assessments that can be used to target and measure efficacy and effectiveness of treatments for preterm infants. As preventive and treatment strategies for CNS injury emerge, these measures of early CNS function provide earlier feedback and help target infants for appropriate intervention. Developing a measurement tool of early CNS function will improve preterm outcomes and optimize the use of health and neurodevelopmental resources for preterm infants.
Publications
Listed is descending order by year published.
Allen MC. Assessment of gestational age and neuromaturation. MRDDRR. 11: 21-33, 2005.
