PREDICTING OUTCOME IN HIGH-RISK NEWBORNS WITH A NEONATAL NEUROBEHAVIORAL ASSESSMENT

Objectives. Effective medical management and rehabilitation efforts in neonates at risk depend on early identification of underlying brain i njury. The aim of this study was to determine the prognostic value of the Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS) in high -risk neonates, and to compare its predictive validity at two stages i n development (i.e., 1 and 3 years of age). Method. Twenty-three healt hy neonates (control group) and 51 high-risk neonates (high-risk group ) were assessed at term and were followed longitudinally. At 1 and 3 y ears, subjects in both groups were evaluated in a blind fashion by a p sychologist and a pediatric neurologist. Results. Developmental delays became more apparent as high-risk newborns matured; the percentage of subjects with an abnormal Griffiths general quotient increased from 1 year (13.7%) to 3 years (39%). Analysis revealed that a normal neonat al performance on the ENNAS in high-risk subjects accurately predicted a favorable outcome at 1 year and 3 years of age. Although an abnorma l ENNAS was not consistently associated with a poor outcome, the posit ive predictive value improved markedly from 1 year to 3 years of age. Conclusion. The findings indicate that a normal neonatal neurobehavior al assessment is reassuring, as most of these children are free of neu rodevelopmental sequelae at 3 years of age. For many persons, the ENNA S may provide early evidence of a pattern of brain injury that is mani fested only as the child is challenged by more complex skill acquisiti on such as language, memory, and perceptual-motor tasks. The ability o f this assessment to predict behavioral and academic skills at school age remains to be determined. Early identification of developmental de ficits enables occupational therapists to direct infants to appropriat e early intervention programs, thus optimizing their functional potent ial.