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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
[Neurodevelopment of extremely low birthweight infants born in Erasmus Hospital between 1992 and 2001]
D Vermeylen1, P Franco, V Wermenbol
1Service des Soins Néonatals intensifs et non intensifs, Hôpital Erasme, U.L.B., Bruxelles.
Insights
Survival rates for extremely low birth weight infants have improved, with better neurological outcomes and reduced severe brain lesions. However, increased survival of very premature infants is linked to a rise in ocular complications.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Neuroscience
Context:
- Survival rates for extremely low birth weight (ELBW) infants have significantly improved.
- Neonatal intensive care unit (NICU) survival rates for infants born before 28 weeks gestational age (GA) or weighing less than 1000g have increased.
- Neurological and developmental outcomes for these infants require ongoing evaluation.
Purpose:
- To evaluate the neurological development of ELBW infants over a decade (1992-2001).
- To compare neurological outcomes between two periods: 1992-1996 and 1997-2001.
- To identify changes in mortality, neurological handicaps, and specific morbidities.
Summary:
- Mortality rates for ELBW infants decreased from 38% to 18% between 1992-1996 and 1997-2001.
- Severe brain lesions, including intraventricular hemorrhage and cystic periventricular leukomalacia, decreased significantly (25% to 6%).
- Major neurological handicaps reduced from 26% to 16%, while normal neurological outcomes increased from 15% to 48%.
Impact:
- Improved multifactorial management in NICUs has led to better survival and neurodevelopmental outcomes for ELBW infants.
- Despite advancements, increasing survival of extremely premature infants (less than 28 weeks GA) is associated with a rise in severe ocular complications (6%).
- Prematurity continues to pose a significant burden on affected children, families, and society, necessitating continued research and improved care strategies.
Abstract:
Survival of extremely low birth weight infants has dramatically improved in the last decade of the twentieth century. The objective of our study was to evaluate the neurological evolution of the surviving infants because frequent motor, sensitive and psychological disturbances are related. Prospective, longitudinal study in a population of newborns, nursed in our neonatal intensive care unit and born between 1992 and 2001 with less than 1.000 g and/or less than 28 weeks of gestational age (GA). Neurological assessment of outcome was made using the neurodevelopmental score (O.M.S. 1988) at 6, 9, 12, 18, 24 and 36 months. Neurological follow-up every year and neuropsychological testing at 3, 5 and 8 years. Only children with at least 2 years of follow-up were included. The children were grouped in 3 categories: M (major neurological handicap), m (minor neurological handicap), N (normal neurological outcome). To evaluate the evolution with time, we compared the results from the first period (1992 to 1996) to the second part of this decade (1997 to 2001). Mortality fell from 38% (27/70) in the first period (1992-1996) to 18% (8/44) in the second one (1997-2001) (p = 0.02) including neonates of less than 25 weeks GA. Neurodevelopmental status improved and severe brain lesions decreased (25% with intraventricular haemorrhage III & IV and cystic periventricular leukomalacia versus 6% in the second period) (p = 0.017). Major handicap fell from 26% (9/34) to 16% (5/31) and normal neurological evolution raised from 15% (5/34) to 48% (15/31) (p = 0.013). With the survival of newborns less than 28 weeks, the severe ocular complications increased: 6% (5/79). In conclusion, mortality and quality of life have significantly improved in the past 10 years in our service. Severe brain lesions have decreased under a better multifactorial management. Nevertheless when the gestational age of the surviving babies diminishes, ocular sequelae increase. We still think that prematurity remains a burden for the child, his family and the society.
