Components of a tool for early detection of development delays in preterm infants : an integrative literature review

Abstract

BACKGROUND Worldwide there is an increase in premature births (before 37 weeks’ gestation) leading to an increased risk of developmental delays, due to the interruption of vital structural intra-uterine development. The premature infant needs to adaptation rapidly to the extra-uterine environment. This rapid adaption can lead to developmental delays in the following areas: gross and fine motor skills; cognition, speech and language; as well as in personal, social or day to day activities. A gap was identified because no screening tool was available for health care professionals in South Africa, for the early detection of developmental delays in premature neonates. OBJECTIVE This study aimed to: 􀁸 explore and describe the best available evidence regarding components to be included in a screening instrument, for use by healthcare professionals, working in a low resource-restricted setting, which aims to detect preterm infants’ developmental delays during follow-up visits during the first year of life. METHODS An integrated literature review was done to identify components needed in a screening tool. Initially 308 studies were collected and imported into the EPPI-reviewer program, whereafter 11 duplicate studies were removed. The remaining 297 studies’ titles and abstracts were read and 237 did not fulfill the inclusion criteria. Thus, 60 studies were prepared for critical appraisal using the Johns Hopkins Critical Appraisal Tool. Thirty-six studies were excluded after critical appraisal due to irrelevant information, not answering the research question or being of low quality. Out of the remaining 24 studies, 20 studies were used to identify the components needed for a screening tool while four studies supported the identified components, acted as a guideline for the 20 useful studies. RESULTS Eleven components of a screening tool for premature infants were identified from 20 studies. These components are: birth weight, gestational age, corrected age, infant specific (focus on each infant as an individual), gender, vital observations, maternal data, parental information,medical conditions (respiratory problems, gastro-intestinal problems, hematologic problems, central nervous system problems, retinopathy of prematurity, intra-ventricular hemorrhage), factors to consider (inflammatory stress, nutritional status, posture, hearing, language, head control, general movement, and sucking), and individualised follow-up dates. CONCLUSION The purpose of a screening tool is the identification of risks for premature infants to experience developmental delays, and not for making diagnoses. As the outcomes of each infant could differ due to the identification of potentially unique developmental delays, a screening tool should be infant-specific while focusing on the components identified during the current study.