Neurodevelopmental outcome in one-year-old children born preterm: differences between low birth weight and very low birth weight.

BACKGROUND: In preterm infants, low birth weight represents one of the major risk factors for health and developmental issues. In Italy, most of the studies are focused on extremely preterm or Very and Extremely Low Birth Weight (VLBW, ELBW) children, whereas little data are available on the neurodevelopmental outcome of Low Birth Weight (LBW) children. We aimed to study the developmental profile of a group of preterm children at 12 months of corrected age, comparing cognitive, language and motor performances between LBW and VLBW. METHODS: We assessed 108 children born preterm (53 LBW and 55 VLBW) at 12 months of corrected age (M= 12.9 months; SD = .95) with Bayley-III. We compared the mean scores between and within groups and the rates of mild and severe delay using the Italian norms. RESULTS: LBW children performed better than VLBW peers, particularly in the cognitive and gross motor areas. No differences between groups were found in relation to language subscales. The rate of mild and severe delay is elevated in both groups, resulting significantly higher in the VLBW group only in the motor area. CONCLUSIONS: These results strongly suggest the need of a multidisciplinary follow-up to monitor the development of premature newborns, including those with birth weights above 1500 g. The early identification of cognitive, language and motor problems is essential to promote children's well-being and intervention prior to school entry.

Do healthy preterm children need neuropsychological follow-up? Preschool outcomes compared with term peers.

AIM: the aim of this study was to determine neuropsychological performance (possibly predictive of academic difficulties) and its relationship with cognitive development and maternal education in healthy preterm children of preschool age and age-matched comparison children born at term. METHOD: a total of 35 infants who were born at less than 33 weeks' gestational age and who were free from major neurosensory disability (16 males, 19 females; mean gestational age 29.4wk, SD 2.2wk; mean birthweight 1257g, SD 327g) and 50 term-born comparison children (25 males, 25 females; mean birthweight 3459g, SD 585g) were assessed at 4 years of age. Cognition was measured using the Griffiths Mental Development scales while neuropsychological abilities (language, short-term memory, visual-motor and constructive spatial abilities, and visual processing) were assessed using standardized tests. Multivariable regression analysis was used to explore the effects of preterm birth and sociodemographic factors on cognition, and to adjust neuropsychological scores for cognitive level and maternal education. RESULTS: the mean total Griffiths score was significantly lower in preterm than in term children (97.4 vs 103.4; p<0.001). Factors associated with higher Griffiths score were maternal university education (ß=6.2; 95% confidence interval [CI] 0.7-11.7) and having older siblings or a twin (ß=4.0; 95% CI 0.5-7.6). At neuropsychological assessment, preterm children scored significantly lower than term comparison children in all tests except lexical production (Boston Naming Test) and visual-processing accuracy. After adjustment for cognitive level and maternal education, differences remained statistically significant for verbal fluency (p<0.05) and comprehension, short-term memory, and spatial abilities (p<0.01). INTERPRETATION: neuropsychological follow-up is also recommended for healthy very preterm children to identify strengths and challenges before school entry, and to plan interventions aimed at maximizing academic success.