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Preterm outcomes research: a critical component of neonatal intensive care
1The Johns Hopkins Hospital, Baltimore, Maryland 21287-3200, USA. mcallen@jhmi.edu
Insights
Neurodevelopmental disability is common in preterm infants, necessitating comprehensive follow-up care beyond neonatal intensive care. Long-term studies are crucial for understanding risks and improving outcomes for these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Neuroscience
Background:
- Preterm infants face higher risks of neurodevelopmental disabilities compared to full-term infants.
- Resource allocation in neonatal intensive care may not adequately address the long-term follow-up needs of preterm survivors and their families.
- Understanding risk factors for central nervous system (CNS) injury in preterm infants is critical.
Purpose of the Study:
- To review the insights gained from preterm outcome studies regarding risk factors and causes of CNS injury.
- To highlight the challenges in predicting individual neurodevelopmental outcomes for preterm infants.
- To emphasize the importance of long-term neurodevelopmental follow-up in neonatal research and clinical practice.
Main Methods:
- Analysis of existing preterm outcome studies.
- Review of randomized controlled trials with neurodevelopmental follow-up.
- Synthesis of findings on perinatal and neonatal treatments and their long-term effects.
Main Results:
- Preterm infants exhibit increased incidence of various neurodevelopmental impairments.
- Perinatal and neonatal risk factors are insufficient predictors of long-term neurodevelopmental disability.
- Long-term follow-up revealed adverse neurodevelopmental effects of some neonatal treatments, such as postnatal steroids.
Conclusions:
- Continued long-term neurodevelopmental studies are essential for preterm infants.
- Evaluating the safety and efficacy of neonatal management strategies requires ongoing research.
- Advances in neonatal intensive care depend on a comprehensive understanding of long-term outcomes and the effectiveness of interventions.
Abstract:
While early preterm outcome studies described the lives of preterm survivors to justify the efforts required to save them, subsequent studies demonstrated their increased incidence of cerebral palsy, mental retardation, sensory impairments, minor neuromotor dysfunction, language delays, visual-perceptual disorders, learning disability and behavior problems compared to fullterm controls. Because infants born at the lower limit of viability require the most resources and have the highest incidence of neurodevelopmental disability, there is concern that resources have gone primarily to neonatal intensive care and are not available for meeting the followup, health, educational and emotional needs of these fragile infants and their families. Despite many methodological concerns, preterm outcome studies have provided insight into risk factors for and causes of CNS injury in preterm infants. Nevertheless, it remains difficult to predict neurodevelopmental outcome for individual preterm infants. Perinatal and neonatal risk factors are inadequate proxies for neurodevelopmental disability. Recent randomized controlled trials with one to five year neurodevelopmental followup have provided valuable information about perinatal and neonatal treatments. Recognizing adverse longterm neurodevelopmental effects of pharmacological doses of postnatal steroids is a sobering reminder of the need for longterm neurodevelopmental followup in all neonatal randomized controlled trials. Ongoing longterm preterm neurodevelopmental studies, analysis of changes in outcomes over time and among centers, and evaluation of the longterm safety, efficacy and effectiveness of many perinatal and neonatal management strategies and proposed neuroprotective agents are all necessary for further medical and technological advances in neonatal intensive care.