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Noordin A.A.1, Simmonds J.V.2, Ronan C.3, Sherwood S.-A.1
1KK Women's and Children's Hospital, Physiotherapy, Singapore, Singapore, 2University College London, Institute of Child Health, London, United Kingdom, 3Barts Health NHS Trust, London, United Kingdom
Background: With increased survival rates of preterm and very low birth weight (VLBW) infants, it is imperative to determine the diagnostic efficacy and cultural sensitivity of neurodevelopmental tests to justify their use clinically. No studies to date have investigated if preterm or post-term (PT) TIMP scores are more predictive of motor development as assessed with the Peabody Developmental Motor Scales Version-2 (PDMS-2). There is also a lack of studies exploring the predictive validity of TIMP version 5 (V5). As gross motor skill development varies between Caucasian and Asian infants, there is a need to study the predictive validity of the TIMP V5 in Asian infants.
Purpose: This study aimed to examine the predictive validity of TIMP V5 at preterm and PT age in preterm, VLBW Asian infants using PDMS-2 locomotion scores as a criterion reference test. A secondary aim was to examine various cutoff values for TIMP V5 and PDMS-2 scores, used to classify infants into normal and delayed motor development, to determine the best cutoffs for prediction of 12 months motor outcome in this population.
Methods: Data were retrospectively collected and analysed from the existing anonymised Neonatal and Obstetric Risk Assessment II database at KK Womens and Childrens Hospital (Singapore) which consists of VLBW infants born at KKH between January 2010 and December 2011. As part of the routine VLBW care pathway at KKH, infants are assessed with the TIMP at 34 weeks post-conception-age (PCA) and 3 months post-term PT by physiotherapists. They are then assessed with the PDMS-2 at 12 months PT. Only infants with at least two TIMP assessments done between 34 weeks PCA and 3 months PT and a subsequent 12 month PT PDMS-2 assessment were included in the study. Chi-square tests were carried out to examine the correlation between TIMP and PDMS-2 scores. Sensitivity, specificity, positive and negative predictive values were calculated using SPSS-22 to determine predictive validity of the TIMP V5.
Results: 138 infants from an original cohort of 349 infants met the criteria for this study. 92% of the cohort was Asian. Participants had mean birthweight of 1021.17(SD=240.85) grams and gestational age of 28.66(SD=2.67) weeks PCA. Infants had initial TIMP assessment at mean age of 38.33(SD=4.36) weeks PCA and repeat TIMP assessment at mean age of 11.52(SD=5.04) weeks PT. PDMS-2 was administered at a mean age of 12.77(SD=1.67) months PT. A statistically significant association was only found between PT TIMP scores and PDMS-2 locomotion scores using cutoff of -1SD on both TIMP and PDMS-2 (Kendalls tau-c=0.128, p=0.031). Specificity (56.07% to 92.52%) was consistently higher than sensitivity (33.33% to 66.67%). Cutoffs of -1 SD on TIMP and PDMS-2 maximised specificity.
Conclusion(s): The TIMP V5 was found to have higher specificity than sensitivity in this study population. Poor diagnostic efficiency at preterm age suggests that there is currently insufficient evidence to justify the need to administer the TIMP at such early ages.
Implications: The findings suggest that TIMP V5 can be used to reassure parents of childs normal development rather than diagnosing motor delay in preterm, VLBW Asian infants.
Funding acknowledgements: None.
Topic: Paediatrics
Ethics approval: Ethical approval was obtained from the Singhealth Centralised Institutional Review Board and from the University College London research ethics committee.
All authors, affiliations and abstracts have been published as submitted.
