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Pediatrics. 2018 May;141(5). pii: e20173091. doi: 10.1542/peds.2017-3091. Epub 2018 Apr 17.

Neurodevelopmental Impairment Among Extremely Preterm Infants in the Neonatal Research Network.

Author information

1
Department of Pediatrics, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia; iadamsc@emory.edu.
2
University of Texas Southwestern Medical Center, Dallas, Texas.
3
Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania.
4
University of Texas Health Science Center at Houston, Houston, Texas.
5
Division of Neonatal and Developmental Medicine, School of Medicine, Stanford University and Lucile Packard Children's Hospital, Palo Alto, California.
6
Department of Pediatrics, Wayne State University, Detroit, Michigan.
7
Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, Rhode Island.
8
Social, Statistical, and Environmental Sciences Unit, Research Triangle Institute International, Research Triangle Park, North Carolina.
9
Social, Statistical, and Environmental Sciences Unit, Research Triangle Institute International, Rockville, Maryland; and.
10
Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.

Abstract

OBJECTIVES:

Evaluate the spectrum of neurodevelopmental outcome in a contemporary cohort of extremely preterm infants. We hypothesize that the rate of severe neurodevelopmental impairment (NDI) decreases over time.

METHODS:

Retrospective analysis of neurodevelopmental outcome of preterm infants ≤27 weeks' gestational age (GA) from a Neonatal Research Network center that completed neurodevelopmental follow-up assessments between April 1, 2011, and January 1, 2015. The Bayley Scales of Infant Development-III (BSID III) and a standardized neurosensory examination were performed between 18 and 26 months' adjusted age. Outcome measures were neurologic examination diagnoses, BSID III cognitive and motor scores, sensory impairment, and the composite outcome of NDI, based on the BSID III cognitive score (analyzed by using a cutoff of <85 or <70), BSID III motor score of <70, moderate or severe cerebral palsy (CP), bilateral blindness, and hearing impairment.

RESULTS:

Two thousand one hundred and thirteen infants with a mean GA of 25.0 ± 1.0 weeks and mean birth weight of 760 ± 154 g were evaluated. The 11% lost to follow-up were less likely to have private insurance, late-onset sepsis, or severe intraventricular hemorrhage. Neurologic examination results were normal in 59%, suspect abnormal in 19%, and definitely abnormal in 22%. Severe CP decreased 43% whereas mild CP increased 13% during the study. The rate of moderate to severe NDI decreased from 21% to 16% when using the BSID III cognitive cutoff of <70 (P = .07) or from 34% to 31% when using the BSID III cognitive cutoff of <85 (P = .67).

CONCLUSIONS:

Extremely preterm children are at risk for NDI. Over time, the rate of moderate to severe NDI did not differ, but the rates of severe CP decreased, and mild CP increased.

PMID:
29666163
PMCID:
PMC5914487
DOI:
10.1542/peds.2017-3091

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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