Assessment of perinatal risk factors

Abstract

The test-retest stability of the Maternal Perinatal Scale (MPS) was examined for a random sample of 41 mothers. The stability of items over a two-day period ranged from 1.00 to 3 5 (r) for items with an underlying normal distribution and from 1.00 to .86 (Cramer's V or Phi coefficient) for nominal items. Moreover, 90% of the coefficients exceeded .90. Intercorrelations between specific information assessed by the items were consistent with clinical obstetric and research evidence. The results were interpreted as lending support to the clinical and research potential of a systematic self-report format in the assessment of perinatal histories.Perinatal complications refer to deviations from the normal pregnancy, labor, delivery, and postdischarge neonatal period. A number of childhood disorders have been linked to developmental histories of perinatal complications (e.g., Commey & Fitzhardinge, 1979; Parnas, Schulsinger, Teasdale, Schulsinger, Feldman, & Mednick, 1982;Pfeiffer, Heffernan, & Pfeiffer, 1985). Although physicians and psychologists have recognized the importance of these factors, research that has attempted to link them to later disorders has been less than conclusive. Thus, while the importance of perinatal difficulties is clear, research and clinical application of such information has been hampered by the lack of a reliable method of assessment.One avenue of research has focused upon the relationship between perinatal complications and children's cognitive development. Results from such investigations have shown that infants who experience perinatal complications tend to manifest a disproportionately higher incidence of developmental delays (e.g., Commey & Fitzhardinge, 1979). In a two-year follow-up study of high-risk infants, Commey and Fitzhardinge found that 21% of the sample had major neurological anomalies, with 42% of these children displaying cognitive/developmental delays. In sum, approximately 50% of this sample displayed behavioral difficulties that were clearly related to the presence of generalized CNS depression (e.g., severe hypotonia, absence of reflexes) on admission to the neonatal intensive care unit (NICU). Of interest to the present discussion, cerebral depression was related to perinatal asphyxia that occurred prior to admission to the NICU.In a more recent investigation, Pfeiffer, Heffernan, and Pfeiffer (1985) assessed the cognitive, behavioral, temperamental, and language functioning of 100 preschool highrisk children. All subjects had neonatal histories of either prematurity and/or medical complications (e.g., intraventricular hemorrhage, neonatal seizures, and perinatal asphyxia). The results showed rather clearly that high-risk infants were more likely later to experience cognitive, neurodevelopmental, and behavioral problems.

Identificación y valoración neuropsicológica del riesgo perinatal: instrumentos

“…De esta manera, se habla de los factores de riesgo perinatales, refiriéndose a ellos como acontecimientos comprometidos que ocurren a lo largo del período perinatal, que se extiende desde la semana 12 de gestación hasta el día 28 de vida del neonato. 10 Estos riesgos pueden derivar en déficits en el desarrollo y en alteraciones comportamentales. Generan, en muchos casos, complicaciones perinatales definidas como "... un término amplio para describir una gran variedad de circunstancias médicas comprometedoras que ocurren alrededor del tiempo del nacimiento, incluyendo el período prenatal y postnatal, al igual que los acontecimientos que se producen en el parto y el alumbramiento".…”

“…La prueba hace un recorrido por un amplio número de factores biológicos y del desarrollo, que se pueden relacionar con posteriores alteraciones neurológicas; con lo cual, ante la presencia de los mismos, se podrían predecir ciertas dificultades, que se llegan a estimar en un 82% de éxito. 10 Mantiene una tasa de estabilidad test-retest que supera el 0,90. 10 Neonatal Neurological Examination (NEONEURO) 66 Ofrece una medida del estado neurológico y comportamental de las ejecuciones del neonato y recién nacido a término.…”

“…10 Mantiene una tasa de estabilidad test-retest que supera el 0,90. 10 Neonatal Neurological Examination (NEONEURO) 66 Ofrece una medida del estado neurológico y comportamental de las ejecuciones del neonato y recién nacido a término. Se compone de 32 ítems que se agrupan en torno a 7 factores: hipertonía, reflejos primarios, tono límbico, reflejos y temblores, estado de alerta y nerviosismo.…”

“…Desde este planteamiento, los niños que han vivido complicaciones durante el período prenatal, durante el parto, o bien en los primeros días del nacimiento, muestran un riesgo considerable frente a trastornos físicos, neuropsicológicos, cognitivos y comportamentales, que se ponen de manifiesto en toda una amplia gama de alteraciones médicas y psicológicas en su desarrollo. 10,11 Estas complicaciones se pueden traducir, desde el punto de vista psicológico, como alteraciones cognitivas y comportamentales, 12 de manera genérica, y muy en particular, en problemas específicos del desarrollo y en la adquisición de ciertas habilidades (p. ej. cálculo, lectura, motricidad).…”

A neuropsychological perspective on perinatal complications and the law

“…Perinatal complications are now becoming an increasingly investigated topic in neuropsychological research (Emory & Mapp, 1988;Emory, Tynan, & Dave, 1989;Gray & Dean, 1988). With some regularity, I am asked by other neuropsychologists and attorneys to consult with them or render an opinion regarding the perinatal contribution to neuropsychological impairments in an infant or child.…”