The reliability of the Molteno Adapted Development Scale in predicting developmental outcomes at 2 years, in prematurely born very low birth weight infants

Abstract

Background: Prematurely born very low birth weight (VLBW) infants are at high risk for neurodevelopmental problems and require regular follow up. Within the South African context, one needs a reliable and user-friendly screening tool to identify those who require intervention. The Molteno Adapted Scale (MAS) is used for this purpose in many clinics, but it has never been validated. Aim: To assess if the MAS performed on young prematurely born infants reliably predicts the neurodevelopmental outcome at 2 years of age as determined by the Griffiths Mental Development Scales (GMDS). Methods: A retrospective study of records of VLBW infants between 1998 and 2006, from the Panorama Medi-Clinic Neonatal Intensive Care Unit follow up clinic. Infants with birth weights < 1500g and accurately assessed gestation < 34 weeks were included. Those who suffered brain insults e.g. meningitis, between the early assessments and the GMDS were excluded. For each child, quotients obtained from the MAS at early assessments were compared to quotients obtained on the GMDS after 2 years of age using Spearman correlations. Results: Fifty-two (27 boys) VLBW infants were included in the study, with a mean birth weight of 981.2 ± 225.5 g and mean gestation of 27.7 ± 1.9 weeks. Thirteen (25%) infants had cerebral palsy and two had visual impairment. MAS assessments were performed at mean ages of 5.1, 10.1 and 16.8 months and the GMDS at a mean age of 28.8 months. Correlations between the MAS and the GMDS ranged from 0.1 - 0.43 at the first assessment, 0.29 - 0.46 at the second assessment and 0.52 - 0.63 at the third assessment. Correlations were statistically significant for the Fine Motor quotient on the MAS at the first assessment, the General quotient and Personal Social quotient at the second assessment, and all quotients except Personal Social at the third assessment. Conclusion: Developmental quotients on the MAS at 5.1 and 10.1 months have a weak positive correlation with the GMDS at 28 months. The MAS at 16.8 months significantly correlated with the developmental outcome as assessed on the GMDS at a mean age of 28 months in prematurely born VLBW infants.