PREDICTION OF OUTCOME AT SCHOOL ENTRY IN NEONATAL INTENSIVE-CARE UNITSURVIVORS, WITH USE OF CLINICAL AND ELECTROPHYSIOLOGIC TECHNIQUES

Objective: To determine the predictive value of multimodality evoked p otentials as well as the neonatal neurobehavioral assessment in neonat al intensive care unit survivors at school entry. Study design: In thi s prospective study, healthy (n = 24) and high-risk newborn infants (n = 78) were assessed in the newborn period with auditory brain-stem re sponses (ABRs) and somatosensory evoked potentials (SEPs), as well as the Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS). Health y and high-risk newborn infants were assessed in a blind fashion at 1, 3, and 5 years of age by a psychologist and a pediatric neurologist. Of those healthy (all 24) and high-risk newborn infants (72/78) with a neonatal ABR, SEP, or both, 62.5% were assessed at 5 years of age wit h the Wechsler Preschool and Primary Scale of Intelligence, the Beery- Buktenica Test of Visual-Motor Integration, the Griffiths Locomotor Su bscale, and neurologic examination. Chi-square analyses were carried o ut on neonatal and outcome measures, and sensitivity, specificity, and predictive values for each of the neonatal tests were ascertained. Re sults: The ENNAS and the ABR had good negative predictive value for co gnitive (85.7% to 93.3%), locomotor (83.3%), and visual-motor (91.4% t o 100%) performance, The ABR had good specificity, whereas the ENNAS w as more sensitive. The SEP was an excellent prognostic tool, with high sensitivity (100%) and specificity (80% to 81.3%) for motor as well a s cognitive domains. All infants with normal SEPs had favorable outcom es, whereas those with absent potentials did poorly. The SEP abnormali ties were associated with findings on neurologic examination in all ca ses. Conclusions: Normal neonatal evoked potentials and ENNAS are asso ciated with favorable outcomes. The SEP most accurately predicts neuro developmental status at school entry.