PEDIATRICS Vol. 115 No. 6 June 2005, pp. 1645-1651 (doi:10.1542/peds.2004-2215)
Changes in Neurodevelopmental Outcomes at 18 to 22 Months' Corrected Age Among Infants of Less Than 25 Weeks' Gestational Age Born in 1993–1999
* Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California
Research Triangle Institute, Research Triangle Park, North Carolina
Women and Infants’ Hospital, Providence, Rhode Island
|| National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
Background. Increased survival rates for extremely preterm, extremely low birth weight infants during the postsurfactant era have been reported, but data on changes in neurosensory and developmental impairments are sparse.
Objective. To compare neuromotor and neurodevelopmental outcomes at 18 to 22 months' corrected age for infants of <25 weeks' estimated gestational age (EGA) who were born in the 1990s.
Methods. This was a multicenter, retrospective, comparative analysis of infants of <25 weeks' EGA, with birth weights of 501 to 1000 g, born between January 1993 and June 1996 (epoch I) or between July 1996 and December 1999 (epoch II), in the National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental assessments were performed at 18 to 22 months' corrected age. Logistic-regression models were constructed to evaluate the independent risk of cerebral palsy, Mental Development Index of <70, Psychomotor Development Index of <70, and neurodevelopmental impairment.
Results. A total of 366 patients in epoch I and 473 patients in epoch II were evaluated. Prenatal steroid use, cesarean section, surfactant treatment, bronchopulmonary dysplasia, and severe retinopathy of prematurity were more likely in epoch II, whereas Apgar scores of <5 at 5 minutes, patent ductus arteriosus, and severe intraventricular hemorrhage were more likely in epoch I. The prevalences of cerebral palsy, Psychomotor Development Index of <70, and neurodevelopmental impairment were similar between epochs. The prevalences of Mental Development Index of <70 were 40% for epoch I and 47% for epoch II. Regression analysis revealed that epoch II was an independent risk factor for Mental Developmental Index of <70 (epoch I versus II: odds ratio: 0.63; 95% confidence interval: 0.45–0.87) but not for other outcomes.
Conclusions. Early childhood neurodevelopmental outcomes among infants of <25 weeks' EGA are not improving in the postsurfactant era, despite more aggressive perinatal and neonatal treatment. Later childhood follow-up assessment is needed to delineate trends in severe cognitive impairment in this extremely high-risk group.
Key Words: extremely low birth weight • extremely premature • surfactant • neurodevelopmental • cerebral palsy • Bayley Scales of Infant Development II
Abbreviations: NDI, neurodevelopmental impairment • BW, birth weight • MDI, Mental Development Index • PDI, Psychomotor Development Index • ROP, retinopathy of prematurity • BPD, bronchopulmonary dysplasia • CI, confidence interval • OR, odds ratio • EGA, estimated gestational age • CP, cerebral palsy • NICHD, National Institute of Child Health and Human Development • IVH, intraventricular hemorrhage • VLBW, very low birth weight • PDA, patent ductus arteriosus • BSID-II, Bayley Scales of Infant Development II
Accepted Jan 20, 2005.
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