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- W2007251145 abstract "The American Academy of Pediatrics has recommended developmental screening and surveillance for all children. Surveillance is defined as the process of recognizing children at risk of developmental delays, and screening as the use of standardized tools to identify and refine that risk.1 Researchers from the Victorian Infant Collaborative Study Group2 report that parent-completed questionnaires are able to differentiate health status between children born extremely preterm/extremely low birthweight (EP/ELBW) and term-born controls, when administered at the age of 8 years. The parent-completed questionnaires under consideration are the Child Health Questionnaire (CHQ), a measure of health status, and the Health Utilities Index Mark 2 (HUI2), a preference-based, multi-attribute, and health-related quality of life measure. Neither of these measures was designed for use as a screening tool. However, both are able to be completed by parents or carers, and the researchers argue both may give information more aligned with the World Health Organization International Classification of Functioning, Disability and Health in comparison with impairment-based clinical assessment. The researchers report sound methodology for the evaluation of these two instruments. Use of downloadable tools such as the STARD statement3 for reporting studies of diagnostic accuracy can assist the reader (and reviewer) in critically analysing this type of study for methodological strengths and weaknesses. In this study, researchers report sensitivities of 0.86 for the HUI2 overall score and 0.96 for the HUI2 disability-specific score in predicting moderate to severe disability status in EP/ELBW children. Specificities of 0.60 and 0.64 for the HUI2 overall score and disability-specific score respectively are also reported.2 These sensitivities are above the recommended cut-off for developmental screening tests but specificities are at the lower range of acceptability.1 The CHQ did not have sufficient sensitivity or specificity to be used for the purposes of screening.2 The HUI2 and HUI3 are generic questionnaires with scoring functions based on preference measurements from random samples of the general population. They represent mean community values and can be used to calculate quality adjusted life years (QALYs) in cost-effectiveness studies.4 They are valid for children aged 5 years or older. The HUI2 consists of six attributes while the HUI3 has eight attributes. It is important to note that although the HUI2 and HUI3 overlap, some of the similarly named attributes have different underlying constructs. In this study, researchers asked parents or carers to complete the HUI2 for their child. The HUI developers recommend proxy-assessed, self- or interviewer-administered versions for children aged 5–8 years, and the self-assessed, interviewer-administered version for 8- to 12-year-olds. The self-assessed, self- or interviewer-administered version is recommended for children 13 years or older.4 However, proxy reporting of health-related quality of life is challenging, particularly for the more subjective domains of social and emotional well-being. Children with chronic disability who self-report on the HUI2 tend to have higher scores than doctors and parents although there is better agreement between child-parent than child-doctor, particularly for subjective areas. Other factors, such as whether the mother or father completed the proxy report, can impact on the scores. These factors should be taken into account by the clinician when reviewing an individual’s responses on the HUI.5 Auditing, education and clinical intervention have been stated as the three goals of current neonatal follow-up programs.6 The use of the HUI2 as a screening tool, as described in this study, is most likely to sit within the audit domain but its use will be limited by the low positive predictive value and the older group of children on whom it has been tested. In addition, there is an expectation that all children born EP/ELBW, who are known to be at risk of developmental disability, are enrolled in some form of surveillance program, whether the neonatal unit outpatient clinic, community paediatrician, or community health centre program. Through these different avenues, children who have moderate or severe disability as defined by the researchers2 should have been identified well before the age of 8 years. Early intervention may then be commenced at an appropriate developmental stage, taking into consideration the need for more evidence on the efficacy of such programs.7 Despite improvements in rates of survival for these smallest and most preterm infants, almost half of this population will have ongoing difficulties with their physical, cognitive, and behavioural development.8 Improvements in cognitive outcome for the latest cohorts of children born preterm have been reported, although assessment of intellectual capacity alone may miss problems in executive functions and behaviour.9 At the age of 8 years, screening should focus on these latter issues, as unlike significant physical or cognitive impairments they are less likely to have been identified at an earlier stage. Researchers from the Victorian Infant Collaborative Study Group10 have previously stated the need for ongoing neuropsychological review throughout middle childhood in this population to identify these problems and plan appropriate intervention. There is little doubt that children born EP/ELBW require surveillance and screening throughout childhood. The use of a tool such as the HUI2 for screening is attractive, in order to lessen the burden on families who may not need to attend multidisciplinary clinics. Further investigation is needed into its use at a younger age and ability to detect more subtle neuropsychological problems, whether it be administered by phone or mailed questionnaire and self-report." @default.
- W2007251145 created "2016-06-24" @default.
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- W2007251145 date "2011-07-11" @default.
- W2007251145 modified "2023-09-23" @default.
- W2007251145 title "Screening for children born extremely preterm and at extremely low birthweight - a role for health-related quality of life measures?" @default.
- W2007251145 cites W1582840748 @default.
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- W2007251145 doi "https://doi.org/10.1111/j.1469-8749.2011.04046.x" @default.
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