Neurodevelopmental outcomes and risk factors of premature infants at corrected gestational age 18~24 months / 中国新生儿科杂志

Objective:To study the neurodevelopmental outcomes and risk factors of premature infants with gestational age (GA) <34 weeks.Methods:From June 2016 to June 2018, premature infants with GA<34 weeks admitted to the Neonatology Department of our hospital were retrospectively reviewed. Bayley Scales of Infant DevelopmentⅡwas used to assess the neurodevelopmental outcomes at corrected GA 18~24 months. The incidence of neurodevelopmental impairment (NDI) was determined. Mental developmental index (MDI) and psychomotor developmental index (PDI) were calculated. The infants were assigned into three groups according to their MDI and PDI scores:≥85 group, 70~84 group and <70 group. Risk factors of low MDI and PDI scores were analyzed.Results:A total of 202 premature infants with GA<34 weeks were included, including 131 males (64.9%) and 71 females (35.1%). 91 cases (45.0%) developed NDI, including 77 mild NDI (38.1%) and 14 severe NDI (6.9%). Univariate analysis found that the incidences of severe asphyxia, multiple births, Grad≥3 ROP and endotracheal intubation in the MDI<70 group were higher. At corrected GA 40 weeks, 3, 6, 12 months, MDI<70 group showed less cases of head circumference >-2SD. PDI<70 group had higher incidences of intrauterine distress, maternal gestational hypertension, multiple birth, Grade 3~4 RDS, Grade 3~4 germinal matrix-intraventricular hemorrhage and tracheal intubation ( P<0.05). Logistic regression showed gestational hypertension, history of tracheal intubation and invasive ventilation were the risk factors for low PDI score ( OR=9.176, 4.547 and 3.227, P<0.05). The head circumference >-2SD at corrected age 6m was protective factor for low MDI and PDI scores ( OR=0.063 and 0.041, P<0.001). Conclusions:Preterm infants with GA<34 weeks are likely to develop severe NDI. Avoiding unnecessary tracheal intubation and invasive ventilation and improving gestational hypertension management may be beneficial to the neurodevelopmental outcomes of preterm infants.

Neurodevelopmental Outcomes of Very Low Birth Weight Infants

PURPOSE: The objective of this study was to observe the neurodevelopmental outcomes of the surviving very low birth weight infants (VLBWIs) and to identify the perinatal risk factors having influences on to poor neurodevelopmental outcomes . METHODS: The VLBWIs weighing 500 to 1,499 g at birth who had survived to discharge from one NICU during about a 2 year period were followed-up and assessed with using the Baley Scales of Infant Development-Second Edition (BSID-II) test and neurologic examinations when the infants corrected age was between 12 and 24 months. Developmental delay was defined as a MDI less than 70 or a PDI less than 70. The birthweight specific rates of developmental delay and cerebral palsy were examined. The perinatal data were retrospectively collected from the medical records to identify peinatal risk factors that had an influence on poor neurologic outcomes. RESULTS: Thirty three (42.9%) of the 77 VLBWIs were assessed with the BSID-II and neurologic examination, when their corrected age was between 12 and 24 months. The rate of developmental delay and cerebral palsy in the assessed infants was 15.2% and 21.2%, respectively. Extremely low birth weight infants (ELBWIs) had high rates of developmental delay (30.8%) and cerebral palsys (30.8%). Maternal old age (>35 years, odds ratio=18.0, 95% CI, 1.2-262.7, P=0.035) and periventricular leukomalacia (PVL, odds ratio=12.6, 95% CI, 1.1-148.1, P=0.044) were independently associated with developmental delay and cerebral palsy, respectively. CONCLUSION: Significant poor neurodevelopmental outcome for the VLBW infants needs a more extended follow-up study for development, and especially for the ELBWIs.

Impact of Perinatal Risk Factors on Mental or Psychomotor Developmental Outcome of Very Low Birth Weight Infants

PURPOSE: To determine which perinatal risk factors influence neurodevelopmental outcome, we try to investigate which perinatal risk factors are correlated with Baley mental or psychomotor developmental index using BSID-II test (Baley Scales of Infant Development, II) in long term follow up of very low birth weight who received neonatal intensive care. METHODS: This study was performed on 56 very low birth weight infants with corrected age 24 months who were admitted to the neonatal intensive care unit. We analyzed correlation between perinatal risk factors and neurodevelopmental outcome assessed by mental and psychomotor developmental index. RESULTS: Mean birth weight was 1317.8+/-168.5g : Small for gestational age was 11 cases and appropriate for gestational age was 45 cases : Mean mental developmental index was 93.8+/-10.3 and psychomotor developmental index was 99.9+/-13.2. Mean developmental scale did not show any significant difference between perinatal risk factors, such as sex, ventilator care and its duration, hospitalization days, birth weight, small for gestational age. Mental or psychomotor developmental score was significantly delayed in the subgroup with grade III intraventricular hemorrhages and periventricular cyst. On cranial ultrasonogram, sinificantly low mental, psychomotor developmental score was found on the subgroup with grade III intraventricular hemorrhages and periventricular cyst formation larger than 3mm size (P<0.01). CONCLUSIONS: These findings suggest that grade III intraventricular hemorrhage and periventricular cyst larger than 3mm size are associated with poor prognostic risk factors regarding to low neurodevelopmental index score.