Neurodevelopment at 2 years corrected age among Vietnamese preterm infants

Abstract

BackgroundPreterm infants are at risk of neurodevelopmental delay, but data on long-term outcomes in low-income and middle-income countries remain scarce.ObjectivesTo examine neurodevelopment using Bayley Scales of Infant and Toddler Development-3rd edition (Bayley-III) and neurological findings in 2-year-old preterm infants, and to compare with healthy Vietnamese infants. Further, to assess factors associated with neurodevelopmental impairment.Design and settingCohort study to follow up preterm infants discharged from a neonatal intensive care unit (NICU) of a tertiary children’s hospital in Vietnam.ParticipantsInfants born at <37 weeks of gestational age.Main outcomesBayley-III assessment and neurological examination at 2-year corrected age (CA) compared with healthy Vietnamese infants.ResultsOf 294 NICU preterm infants, Bayley-III scores of all 184/243 (76%) survivors at 2 years CA were significantly lower than those of healthy Vietnamese peers in all three domains: cognition (mean (SD): 84.5 (8.6) vs 91.4 (7.5), p<0.001), language (mean (SD): 88.7 (12.5) vs 95.9 (11.9), p<0.001) and motor (mean (SD): 93.1 (9.0) vs 96.8 (9.3), p=0.003). The mean differences in Bayley-III scores between preterm and healthy Vietnamese infants were −6.9 (−9.1 to −4.7), −7.2 (−10.5 to −3.8) and −3.7 (−6.1 to −1.2) for cognitive, language and motor scores, respectively. The prevalence of neurodevelopmental impairment was 17% for cognitive, 8% for language and 4% for motor performance. In total, 7% were diagnosed with cerebral palsy. Higher maternal education was positively associated with infant neurodevelopment (OR 0.32, 95% CI 0.11 to 0.94).ConclusionsVietnamese preterm infants in need of neonatal intensive care showed poor neurodevelopment at 2 years. Higher maternal education was positively associated with infant neurodevelopment. Standard follow-up programmes for preterm infants should be considered in low-resource settings.

Counting every small and sick newborn: better data, better care

“…Choung Do et al 2 provide a valuable contribution to the small but growing literature regarding neonatal neurodevelopmental outcomes in LMICs through their assessment of preterm newborns discharged from Children’s Hospital 1, Ho Chi Minh City, Vietnam 2. Their prospective cohort, though single-institution, is methodologically strong with inclusion of a control group, use of a locally adapted and validated child development assessment tool, and inclusion of vision and hearing outcomes 2.…”

“…Choung Do et al 2 provide a valuable contribution to the small but growing literature regarding neonatal neurodevelopmental outcomes in LMICs through their assessment of preterm newborns discharged from Children’s Hospital 1, Ho Chi Minh City, Vietnam 2. Their prospective cohort, though single-institution, is methodologically strong with inclusion of a control group, use of a locally adapted and validated child development assessment tool, and inclusion of vision and hearing outcomes 2. Their finding that over half (55%, n=101/184) of infants followed had evidence of neurodevelopmental impairment, which was severe in 23% (n=43/183), emphasises the public health importance of newborn conditions for long-term health and development in every setting 2.…”

“…Their prospective cohort, though single-institution, is methodologically strong with inclusion of a control group, use of a locally adapted and validated child development assessment tool, and inclusion of vision and hearing outcomes 2. Their finding that over half (55%, n=101/184) of infants followed had evidence of neurodevelopmental impairment, which was severe in 23% (n=43/183), emphasises the public health importance of newborn conditions for long-term health and development in every setting 2. The paper also highlights challenges in measuring neurodevelopment including;…”

“…As is common practice in newborn outcomes research, Choung Do et al used the Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) as part of assessing neurodevelopmental impairment in their study cohort 2. However, as the authors note, there is increasing evidence that the Bayley-III overestimates current developmental status and is a poor predictor of future performance, underidentifying future language and cognitive delays even in HIC 2 3. These limitations need to be balanced with substantial costs of undertaking Bayley-III assessments, even in research applications.…”

“…Caregivers of preterm and seriously ill newborns are likely to experience high levels of stress and distress and these factors may affect caregiving. Outcome studies such as that of Choung Do et al provide limited baseline data regarding caregiver demographics 2. However, in ongoing research, increased emphasis on measurement of caregiver and environmental factors is needed to inform development of family focused models of newborn care and follow-up, including opportunities for early intervention.…”