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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Minor neurological dysfunction, cognitive development, and somatic development at the age of 3 to 7 years after
J Kutschera1, J Tomaselli, U Maurer
1Department of Paediatrics, University Hospital, Auenbruggerplatz 30, Graz A-8036, Austria. joerg.kutschera@klinikum-graz.at
Insights
Dexamethasone therapy in very-low-birthweight infants was linked to poorer motor skills and higher rates of minor neurological dysfunction. Long-term effects on neurological and cognitive development require further study.
Area of Science:
- Neonatal care
- Pediatric neurology
- Developmental pediatrics
Background:
- Very-low-birthweight (VLBW) infants often require medical interventions.
- Dexamethasone is used to treat conditions like bronchopulmonary dysplasia in VLBW infants.
- Potential long-term neurodevelopmental effects of early dexamethasone exposure are a concern.
Purpose of the Study:
- To evaluate the impact of early dexamethasone therapy on neurodevelopmental outcomes in VLBW infants.
- To compare minor neurological dysfunction, cognitive, and somatic development between treated and untreated VLBW children.
- To identify specific areas of development affected by dexamethasone treatment.
Main Methods:
- A case-control study matched 33 VLBW infants treated with dexamethasone to 33 controls.
- Dexamethasone treatment occurred between days 7-28 of life over 7 days.
- Neurodevelopmental assessments, including neurological exams and cognitive tests (Kaufman Assessment Battery for Children, Draw-a-Man Test), were performed at 3-7 years of age.
Main Results:
- No significant differences were observed in demographic data, growth, or socio-economic status.
- Children treated with dexamethasone exhibited significantly poorer fine and gross motor skills (p<0.01).
- The control group performed significantly better on the Draw-a-Man Test (p<0.001), indicating better visual-motor integration.
Conclusions:
- Early dexamethasone therapy in VLBW infants is associated with an increased rate of minor neurological dysfunction.
- Motor development, particularly fine and gross motor skills, appears negatively impacted by dexamethasone exposure.
- Neurological development may be subtly affected even in the absence of overt neurological diagnoses, necessitating long-term follow-up.
Abstract:
The objective of this study was to assess minor neurological dysfunction, cognitive development, and somatic development after dexamethasone therapy in very-low-birthweight infants. Thirty-three children after dexamethasone treatment were matched to 33 children without dexamethasone treatment. Data were assessed at the age of 3-7 years. Dexamethasone was started between the 7th and the 28th day of life over 7 days with a total dose of 2.35 mg/kg/day. Exclusion criteria were asphyxia, malformations, major surgical interventions, small for gestational age, intraventricular haemorrhage grades III and IV, periventricular leukomalacia, and severe psychomotor retardation. Each child was examined by a neuropediatrician for minor neurological dysfunctions and tested by a psychologist for cognitive development with a Kaufman Assessment Battery for Children and a Draw-a-Man Test. There were no differences in demographic data, growth, and socio-economic status between the two groups. Fine motor skills and gross motor function were significantly better in the control group (p<0.01). In the Draw-a-Man Test, the control group showed better results (p<0.001). There were no differences in development of speech, social development, and the Kaufman Assessment Battery for Children. After dexamethasone treatment, children showed a higher rate of minor neurological dysfunctions. Neurological development was affected even without neurological diagnosis. Further long-term follow-up studies will be necessary to fully evaluate the impact of dexamethasone on neurological and cognitive development.
