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Pediatr Neurol. 2018 Feb;79:45-52. doi: 10.1016/j.pediatrneurol.2017.11.002. Epub 2017 Nov 13.

Co-occurrence and Severity of Neurodevelopmental Burden (Cognitive Impairment, Cerebral Palsy, Autism Spectrum Disorder, and Epilepsy) at Age Ten Years in Children Born Extremely Preterm.

Author information

1
Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. Electronic address: rachel.hirschberger@childrens.harvard.edu.
2
Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
3
University of North Carolina, Chapel Hill, North Carolina.
4
Department of Psychology and Neuroanatomy, Boston University, Boston, Massachusetts.
5
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
6
Division of Pediatric Neurology, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland.
7
Department of Radiology, Boston Medical Center, Boston University, Boston, Massachusetts.
8
Departments of Psychiatry and Pediatrics, UMASS Medical School/ University of Massachusetts Memorial Health Care, Worcester, Massachusetts.
9
National Institute of Neurological Disorders and Stroke, Bethesda, Maryland.
10
Department of Epidemiology and Biostatistics and Pediatrics and Human Development, Michigan State University, East Lansing, Michigan.
11
Boston Children's Hospital, Boston, Massachusetts.
12
Tufts Medical Center, Boston, Massachusetts.
13
Baystate Medical Center.
14
University of Massachusetts Medical School, Worcester, Massachusetts.
15
Yale University School of Medicine, New Haven, Connecticut.
16
Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.
17
University Health Systems of Eastern Carolina, Greenville, North Carolina.
18
North Carolina Children's Hospital, Chapel Hill, North Carolina.
19
Helen DeVos Children's Hospital, Grand Rapids, Michigan.
20
Sparrow Hospital, Lansing, Michigan.
21
University of Chicago Medical Center, Chicago, Illinois.
22
William Beaumont Hospital, Royal Oak, Michigan.

Abstract

BACKGROUND:

This study aims to determine the prevalence of neurodevelopmental impairments at age ten years among children born extremely preterm (less than 28 weeks gestational age) and to offer a framework for categorizing neurological limitations.

METHODS:

A multicenter, prospective cohort follow-up study recruited 889 ten-year-old children born from 2002 to 2004. We assessed prevalence of cognitive impairment, measured by intelligent quotient and tests of executive function, cerebral palsy (CP), autism spectrum disorder (ASD), and epilepsy singly and in combination. The three levels of impairment severity were: category I-no major neurodevelopmental impairment; category II-normal cognitive ability with CP, ASD, and/or epilepsy; and category III-children with cognitive impairment.

RESULTS:

A total 214 of 873 children (25%) had cognitive impairment, 93 of 849 children (11%) had CP, 61 of 857 children (7%) had ASD, and 66 of 888 children (7%) had epilepsy. Further, 19% of all children had one diagnosis, 10% had two diagnoses, and 3% had three diagnoses. Decreasing gestational age was associated with increasing number of impairments (P < 0.001). Half the children with cognitive impairment and one third of children with CP, ASD, or epilepsy had a single impairment. Six hundred one (68% [95% CI, 64.5%-70.7%]) children were in category I, 74 (8% [95% CI, 6.6%-10.3%]) were in category II, and 214 (24% [95% CI 21.7%-27.4%]) were in category III.

CONCLUSIONS:

Three quarters of children had normal intellect at age ten years; nearly 70% were free of neurodevelopmental impairment. Forty percent of children with impairments had multiple diagnoses.

KEYWORDS:

extremely preterm; follow-up; multiple disabilities; neurological

PMID:
29310907
PMCID:
PMC5803305
[Available on 2019-02-01]
DOI:
10.1016/j.pediatrneurol.2017.11.002

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