Reply

Sir,Many attempts have been made to predict the outcomeof high-risk infants as neonatal risk determination is acomplex question. These models often focus onphysiological variables during the first hours or daysof life, but also on neurological imaging or the presenceof complications (1). The outcome measures also differbut what is of greatest interest is neurological dysfunc-tion later in life. Other adverse outcomes, e.g. infections(2, 3), delayed first stool (4) or affected thyroid function(5), have also been studied.

In most cases the measure and the outcome reflect thesame underlying problem: extreme prematurity. Thereis, for instance, an increased incidence of an adverseneurodevelopmental or sensory outcome with increasedseverity of chronic lung disease (6). This kind ofinstrument will, of course, be a good determinant oflater outcome, but what would be even more valuablewould be to find an easy-to-use instrument based ondata close in time to admission that could predictneurological outcome at school-age or later. Asneonatal illness and neonatal care are complex situa-tions, a considerable amount of research effort is neededto find such a system. We welcome the initiative ofSamson and de Groot (7) and of others in striving tosearch for this system.

References1. Richardson DK, Tarnow-Mordi WO, Escobar GJ. Neonatal risk

scoring systems. Can they predict mortality and morbidity? ClinPerinatol 1998; 25: 591–611

2. Gray JE, Richardson DK, McCormick MC, Goldmann DA.Coagulase-negative staphylococcal bacteremia among very lowbirth weight infants: relation to admission illness severity,resource use, and outcome. Pediatrics 1995; 95: 225–30

3. Fowlie PW, Gould CR, Parry GJ, Phillips G, Tarnow-Mordi WO.CRIB (clinical risk index for babies) in relation to nosocomialbacteraemia in very low birthweight or preterm infants. Arch DisChild Fetal Neonatal Ed 1996; 75: F49–52

4. Kumar SL, Dhanireddy R. Time of first stool in premature infants:effect of gestational age and illness severity. J Pediatr 1995; 127:971–4

5. Meyers-Seifer C, Grant W, Mayes D, Almeida P, Capuano S,James R, et al. Illness severity predicts thyroid function in verylow birthweight (vlbw) infants during the first 6 postnatal weeks.Pediatr Res 1996; 39: 93A

6. deRegnier RA, Roberts D, Ramsey D, Weaver RG, Jr, O’SheaTM. Association between the severity of chronic lung disease andfirst-year outcomes of very low birth weight infants. J Perinatol1997; 17: 375–82

7. Samson JF, de Groot L. Comment on the article by Eriksson et al.Acta Pædiatr 2003; 92: 873.

M Eriksson and J Schollin, Department of Paediatrics, OrebroUniversity Hospital, SE-701 85 Orebro, Sweden. Correspondence:M Eriksson, Department of Paediatrics, Orebro UniversityHospital, SE-701 85 Orebro, Sweden (E-mail. mats.eriksson@orebroll.se)

CORRESPONDENCE SECTION

Predictors of outcome. Comment on the article by Eriksson et al. (1)

Sir,All the indices used in the study by Eriksson et al. (1)were better predictors of early outcome than outcome at4 y of age in newborns with birthweights (BW) below1500 g. We studied the prediction of minor neurologicaldysfunction (MND, examination of Touwen, (2)) at 7 yin children born as high-risk preterm infants (gestationalage (GA) 32 wk and/or BW 1500 g and NeonatalMedical Index III (NMI) of Korner et al. (3, 4)).Perinatal factors such as GA, BW, small for GA, dayson the ventilator and/or days on continuous positiveairway pressure, brain ultrasound classification andNMI were used to predict outcome at 7 y in thesechildren. We were able to predict MND at 7 y using theNMI categorization and the gender of the child with asensitivity of 92 and positive predictive value of 81(specificity 47 and negative predictive value 70) (5).

References1. Eriksson M, Bodin L, Finstrm O, Schollin J. Can severity-of-

illness indices for neonatal intensive care predict outcome at 4years of age? Acta Pædiatr 2002; 91: 1093–100

2. Touwen BCL. The examination of the child with minor neuro-logical dysfunction. In: Clinics developmental medicine. London:Heinemann; 1979

3. Korner AF, Stevenson DK, Kraemer HC. Prediction of thedevelopment of low birthweight preterm infants by a new medicalindex. J Dev Behav Pediatr 1993; 14: 106–11

4. Korner AF, Stevenson DK, Forest T. Preterm medical complica-tions differentially affect preterm infants by a new neonatalmedical index. Infant Behav Dev 1994; 17: 37–43

5. Samsom JF, de Groot L, Bezemer PD, Lafeber HN, Fetter WPF.Muscle power development during the first year of life predictsneuromotor behaviour at 7 years in preterm born high-risk infants.Early Human Dev 2002; 68: 103–18.

JF Samsom and L de Groot, Department of Paediatrics, Divisionof Neonatology, VU University Medical Centre, De Boelelaan,Amsterdam, The Netherlands. Correspondence to: Janny F Sam-som, Department of Paediatrics, Division of Neonatology, VUUniversity Medical Centre, De Boelelaan 1118, POB 7057, NL-1007 MB, Amsterdam, The Netherlands (E-mail. J.Samsom@-vumc.nl)

Received Feb. 7, 2003; accepted Mar. 26, 2003

DOI 10.1080/08035250310003613DOI 10.1080/08035250310003622 2003 Taylor & Francis. ISSN 0803-5253

ACTA PÆDIATR 92 (2003) Correspondence section 873