Early Neurological Assessment and Long-Term Neuromotor Outcomes in Late Preterm Infants: A Critical Review

Abstract

Background and Objectives: Late preterm (LP) infants (born between 34 and 36 weeks of gestational age) are considered at higher risk of neonatal morbidities, mortality, and neurological impairments than full-term born infants (FT). The aim of this study was to provide a critical review of the literature outlining the different aspects of neurological function reported both in the neonatal period and in the follow up of late preterm infants. Materials and Methods: A comprehensive search of the MEDLINE, Embase, PsycINFO, and CINAHL electronic databases was made, using the following search terms: ‘Late preterm infants’, ‘Near term infants’, ‘neurological assessment’, ‘neurological outcome’, ‘neuromotor outcome’, cerebral palsy’, ‘CP’, ‘motor impairment’, including all the studies reporting clinical neurological assessment of LP (including both neonatal period and subsequent ages). Results: A total of 35 articles, comprising 301,495 children, were included as fulfilling the inclusion criteria: ten reported neonatal neurological findings, seven reported data about the first two years after birth, eighteen reported data about incidence of CP and motor disorder during the infancy. Results showed a more immature neurological profile, explored with structured neurological assessments, in LP infants compared with FT infants. The LP population also had a higher risk of developing cerebral palsy, motor delay, and coordination disorder. Conclusion: LP had a higher risk of neurological impairments than FT infants, due to a brain immaturity and an increased vulnerability to injury, as the last weeks of gestational age are crucial for the development of the brain.

Hammersmith Infant Neurological Examination in low‐risk infants born very preterm: a longitudinal prospective study

“…The use of the HINE in low‐risk infants has been reported less widely. Previous studies suggested that both infants born preterm and late preterm have a different profile of neurological maturation compared to infants born at term, with wider variability of neurological findings 11,13,17 . When using the normative data collected for infants born at term, 13,16 50% of infants born preterm with scores at 12 months considered suboptimal (< 73) had a typical outcome, suggesting that the spectrum of findings associated with a typical outcome in infants born preterm is wider than in infants born at term.…”

“…Previous studies suggested that both infants born preterm and late preterm have a different profile of neurological maturation compared to infants born at term, with wider variability of neurological findings. 11,13,17 When using the normative data collected for infants born at term, 13,16 50% of infants born preterm with scores at 12 months considered suboptimal (< 73) had a typical outcome, suggesting that the spectrum of findings associated with a typical outcome in infants born preterm is wider than in infants born at term. This information is of great interest to physicians involved in the follow-up of infants born preterm because it allows separation of infants born preterm with a neurological profile consistent with their gestational age from those who should be investigated further.…”

Neurological Surveillance in Moderate-Late Preterm Infants—Results from a Dutch–Canadian Survey

“…Implementation of routine neurological examination and post-discharge follow-up, in combination with GMAs around term equivalent age and post-term, can, therefore, be beneficial in MLPT infants. Early identification of developmental delay, or risk thereof, is important to facilitate timely intervention and therewith optimize neurodevelopmental outcomes [ 3 , 31 ].…”

Neurological development and iron supplementation in healthy late-preterm neonates: a randomized double-blind controlled trial

“…No differences are described in the hearing and speech subscale, and this was confirmed in our sample. The neuromotor fall applies in LPT probably due to a brain immaturity and an increased vulnerability to injury, as the last 6 weeks of gestation are essential for the cortical gray and white matter development [30]. Iron supplementation could have improved the brain development in LPT mainly in the neurological areas that are usually delayed in these infants as showed by the higher scores in infants in the iron group than those in the placebo group; this could further justify the higher DQ in the iron group.…”