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PEDIATRICS Vol. 113 No. 2 February 2004, pp. 416-419

EXPERIENCE AND REASON

An Evidence-Based Approach to Predicting Low IQ in Very Preterm Infants From the Neurological Examination: Outcome Data From the Indomethacin Intraventricular Hemorrhage Prevention Trial

Michael D. Pleacher, MD^*, Betty R. Vohr, MD, Karol H. Katz, MS, Laura R. Ment, MD and Walter C. Allan, MD^*

^* Department of Pediatrics, Division of Pediatric Neurology, Maine Medical Center, Portland, Maine
Department of Pediatrics, Brown University Medical School, Providence, Rhode Island
Departments of Pediatrics, Neurology, Neurosurgery, Epidemiology, and Public Health, Yale University School of Medicine, New Haven, Connecticut

We evaluated whether the degree of cerebral palsy (CP) at age 3 in very preterm children is predictive of full-scale intelligence quotient (FSIQ) <70 at age 8 by calculating likelihood ratios (LRs) for findings on the neurologic examination. Data from the follow-up phase of the Indomethacin Intraventricular Hemorrhage Prevention Trial, which includes periodic neurologic examination and neuropsychometric testing, were used. Information was available on 366 of 440 (83%) children with birth weight of 600 to 1250 g who survived. Neurologic examination at age 3 was grouped by presence and type of CP, and the Weschler Intelligence Scale for Children–Third Edition FSIQ at age 8 was grouped dichotomously (<70 or 70). CP was identified in 35 of 366 3-year-olds (9.5%). An FSIQ <70 was identified in 47 of 366 children at 8 years old (12.8%). FSIQ <70 occurred in 14 of 17 children with tri- or quadriplegia (82%), 8 of 18 children with di- or hemiplegia (44%), and 25 of 331 children without CP (7.5%). Useful LRs were calculated for tri- or quadriplegia (30), di- or hemiplegia (5.7), and children without CP (0.55). These LRs have greater impact on posttest odds for FSIQ <70 than those for birth weight <1000 g, history of bronchopulmonary dysplasia, and Stanford-Binet Intelligence Score <70 at age 3. We conclude that the neurologic examination at 3 years old predicts FSIQ <70 at age 8 with LRs that allow evidence-based parental counseling and intervention planning.

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Key Words: evidenced-based medicine • premature infant • cerebral palsy • mental retardation

Abbreviations: LR, likelihood ratio • IQ, intelligence quotient • CP, cerebral palsy • BPD, bronchopulmonary dysplasia • SBIS, Stanford-Binet Intelligence Score • WISC-III, Weschler Intelligence Scale for Children–Third Edition • FSIQ, full-scale IQ • VIQ, verbal IQ • PIQ, performance IQ • PPV, positive predictive value • VLBW, very low birth weight

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Received for publication May 30, 2003; Accepted Oct 29, 2003.

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