Neonatal Factors Associated with a Good Neurodevelopmental Outcome in Very Preterm Infants

Abstract

Objective This study aims to examine the association between the absence of neonatal comorbidities, as well as the presence of indicators of clinical progress with good neurodevelopmental (ND) outcomes, at 18 months corrected age in a national cohort of preterm infants of < 29 weeks' gestation.

Design Study subjects included preterm infants (< 29 weeks' gestation) born in 2010 and 2011. Univariate analyses were conducted and regression estimates were calculated for variables where odds of a good ND outcome, composite scores ≥ 100 in three domains (cognitive, language, and motor) in the Bayley Scales of Infant and Toddler Development, 3rd ed. (Bayley-III), were estimated.

Results In total, 2,069 infants were included in the analyses. For all three domains evaluated on the Bayley-III, cognition, language, motor, respectively, the absence of three major morbidities was associated with a score ≥ 100: bronchopulmonary dysplasia, necrotizing enterocolitis, and severe neurological injury. Less time spent on positive pressure support and on total parenteral nutrition administration were associated with a positive motor outcome and showed a positive trend for both cognition and language scores.

Conclusion The absence of neonatal comorbidities was associated with good ND outcome. Less time spent on positive pressure support and parenteral nutrition may also contribute to a good ND outcome.

Keywords

good neurodevelopmental outcomes - absence of severe morbidities - very preterm infants - clinical care

• References

• 1 Wilcox LS, Kiely JL, Melvin CL, Martin MC. Assisted reproductive technologies: estimates of their contribution to multiple births and newborn hospital days in the United States. Fertil Steril 1996; 65 (2) 361-366
• 2 Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2013. Natl Vital Stat Rep 2015; 64 (1) 1-65
• 3 Hack M, Wilson-Costello D, Friedman H, Taylor GH, Schluchter M, Fanaroff AA. Neurodevelopment and predictors of outcomes of children with birth weights of less than 1000 g: 1992-1995. Arch Pediatr Adolesc Med 2000; 154 (7) 725-731
• 4 Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med 2000; 343 (6) 378-384
• 5 Schmidt B, Asztalos EV, Roberts RS, Robertson CM, Sauve RS, Whitfield MF ; Trial of Indomethacin Prophylaxis in Preterms (TIPP) Investigators. Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months: results from the trial of indomethacin prophylaxis in preterms. JAMA 2003; 289 (9) 1124-1129
• 6 Wilson-Costello D, Friedman H, Minich N , et al. Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002. Pediatrics 2007; 119 (1) 37-45
• 7 Canadian Neonatal Network Available at: http://www.canadianneonatalnetwork.org/portal/CNNHome/AbstractorsPage.aspx . Accessed May 18, 2016
• 8 Canadian Neonatal Follow-up Network Available at: http://www.cnfun.ca . Accessed May 18, 2016
• 9 Bayley N. Bayley Scales of Infant and Toddler Development®. 3rd ed. San Antonio, TX: NCS Pearson, Inc.; 2006
• 10 Anderson PJ, De Luca CR, Hutchinson E, Roberts G, Doyle LW ; Victorian Infant Collaborative Group. Underestimation of developmental delay by the new Bayley-III Scale. Arch Pediatr Adolesc Med 2010; 164 (4) 352-356
• 11 Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008; 371 (9608): 261-269
• 12 Scheiner AP, Sexton ME. Prediction of developmental outcome using a perinatal risk inventory. Pediatrics 1991; 88 (6) 1135-1143
• 13 Joseph KS, Kramer MS, Allen AC , et al; Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. Gestational age- and birthweight-specific declines in infant mortality in Canada, 1985-94. Paediatr Perinat Epidemiol 2000; 14 (4) 332-339
• 14 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163 (7) 1723-1729
• 15 Ehrenkranz RA, Walsh MC, Vohr BR , et al; National Institutes of Child Health and Human Development Neonatal Research Network. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005; 116 (6) 1353-1360
• 16 Bhandari A, Bhandari V. Pitfalls, problems, and progress in bronchopulmonary dysplasia. Pediatrics 2009; 123 (6) 1562-1573
• 17 Loÿs CM, Maucort-Boulch D, Guy B, Putet G, Picaud JC, Haÿs S. Extremely low birthweight infants: how neonatal intensive care unit teams can reduce postnatal malnutrition and prevent growth retardation. Acta Paediatr 2013; 102 (3) 242-248
• 18 Lapointe M, Barrington KJ, Savaria M, Janvier A. Preventing postnatal growth restriction in infants with birthweight less than 1300 g. Acta Paediatr 2016; 105 (2) e54-e59