Neurodevelopmental outcomes following late and moderate prematurity: a population-based cohort study

Abstract

ObjectiveThere is a paucity of data relating to neurodevelopmental outcomes in infants born late and moderately preterm (LMPT; 32+0–36+6 weeks). This paper present the results of a prospective, population-based study of 2-year outcomes following LMPT birth.Design1130 LMPT and 1255 term-born children were recruited at birth. At 2 years corrected age, parents completed a questionnaire to assess neurosensory (vision, hearing, motor) impairments and the Parent Report of Children's Abilities-Revised to identify cognitive impairment. Relative risks for adverse outcomes were adjusted for sex, socio-economic status and small for gestational age, and weighted to account for over-sampling of term-born multiples. Risk factors for cognitive impairment were explored using multivariable analyses.ResultsParents of 638 (57%) LMPT infants and 765 (62%) controls completed questionnaires. Among LMPT infants, 1.6% had neurosensory impairment compared with 0.3% of controls (RR 4.89, 95% CI 1.07 to 22.25). Cognitive impairments were the most common adverse outcome: LMPT 6.3%; controls 2.4% (RR 2.09, 95% CI 1.19 to 3.64). LMPT infants were at twice the risk for neurodevelopmental disability (RR 2.19, 95% CI 1.27 to 3.75). Independent risk factors for cognitive impairment in LMPT infants were male sex, socio-economic disadvantage, non-white ethnicity, preeclampsia and not receiving breast milk at discharge.ConclusionsCompared with term-born peers, LMPT infants are at double the risk for neurodevelopmental disability at 2 years of age, with the majority of impairments observed in the cognitive domain. Male sex, socio-economic disadvantage and preeclampsia are independent predictors of low cognitive scores following LMPT birth.

Correcting for prematurity affects developmental test scores in infants born late and moderately preterm

“…[2][3][4][5] These problems are evident in infancy and recent population-based studies have shown that children born LMPT are at twice the risk for neurodevelopmental disability compared with term-born controls at two years of age. [6] Developmental assessments in the early years are regarded as important for identifying children at risk and for targeting early intervention. [7,8] As such, developmental tests at two years are widely used to assess neurodevelopmental outcomes and to ascertain eligibility for intervention services.…”

Efeitos da prematuridade na aquisição da linguagem e na maturação auditiva: revisão sistemática

“…However, the study suggests that gestational age, low weight at birth and gender may be more influential in the long term in these children, thus being necessary to monitor this population -as has been observed in other studies reviewed (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) . These results evidenced the importance of monitoring these children from birth, although none of them followed-up on psychological factors such as those proposed by Kupfer et al (39) , indicated as closely related to language acquisition (40) .…”

“…Psychosocial aspects such as maternal mood, particularly maternal depression during the first six months after birth, were not associated with language abnormalities at 18 months according to the Bayley Scales (16) . In assessing performing functions and their relation to language, several studies indicated a positive correlation between attention abnormalities and other performing functions and poorer language performance (22,27) , having also related it to lower gestational age (27) and poorer nonverbal learning (27) . Premature children presented poorer performing functions (22) , although they are not different from full-term infants in terms of attention-deficit and hyperactivity disorder (21) .…”

“…Some of the studies verified impairments related to language outcomes in premature children, these having presented compromised language in relation to full-term children (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) . A study (19) also found association with hearing impairment.…”

“…The studies selected were divided into works that aimed to assess the effects and risks of the association of abnormalities and other aspects of development with prematurity. In these, assessments of language and hearing were part of the procedures to carry out such studies in a complementary basis (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) . On the other hand, other studies found focused mainly on language and/or hearing impairments in premature infants (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) .…”