Neurodevelopmental impairment among extremely preterm infants in the neonatal research network

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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.

Original languageEnglish
Article numbere20173091
Issue number5
StatePublished - May 2018

Bibliographical note

Funding Information:
FUNDING: The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10 HD21364, U10 HD21373, U10 HD21385, U10 HD27851, U10 HD27853, U10 HD27856, U10 HD27880,U10 HD27904, U10 HD34216, U10 HD36790, U10 HD40492, U10 HD40689, U10 HD53089, U10 HD53109, U10 HD68244, U10 HD68270, U10 HD68278, U10 HD68263, U10 HD68284) and the National Center for Advancing Translational Sciences (UL1 TR6, UL1 TR41, UL1 TR42, UL1 TR77, UL1 TR93, UL1 TR442, UL1 TR454, UL1 TR1117) provided grant support for the Neonatal Research Network, including for the follow-up study. Although National Institute of Child Health and Human Development staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funded by the National Institutes of Health (NIH).

Publisher Copyright:
© Copyright 2018 by the American Academy of Pediatrics.

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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