Neonatal Assessment Visual European Grid accuracy in detecting infants born preterm at risk of neurological impairment

Aim: To analyse the factorial structure of the Neonatal Assessment Visual European Grid (NAVEG), its diagnostic accuracy, the discriminative capacity of its individual items, and total score in detecting infants born preterm with neurological and/or brain ultrasound anomalies. Method: A total of 109 infants born preterm and 79 born at term underwent a visual function assessment using the NAVEG, a neurological examination based on the Amiel-Tison Neurological Assessment (ATNAT), and, for infants born preterm, brain ultrasound imaging. Exploratory factor analysis, diagnostic accuracy, discriminative capacity, and differences in NAVEG scores among infants born preterm and at term were calculated. Results: The exploratory factor analysis revealed that 16 out of the 17 items in NAVEG accounted for 61% of the variance in a one-factor solution model. Receiver operating characteristic curves demonstrated the discriminative capacity of NAVEG in detecting neurological signs for a total score of 3 or higher. Good levels of sensitivity and specificity were observed in infants born preterm, with ATNAT scores as reference (sensitivity 93.02%; specificity 78.79%) or in combination with brain ultrasound results (sensitivity 84.89%; specificity 83.93%). The most discriminative NAVEG items in detecting the presence of neurological signs in infants born preterm were oculomotor functions and visual field. Significant differences were found in the visual profiles of infants born preterm with neurological signs and/or brain ultrasound anomalies compared with those without these anomalies, and with infants born at term. Interpretation: NAVEG could be a useful screening tool in infants born preterm to evaluate visual dysfunctions and to detect those with neurological signs and/or brain ultrasound anomalies.