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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Neurodevelopmental outcomes of extreme-low-birth-weight infants born between 2001 and 2002
Insights
Extreme-low-birth-weight survivors face significant neurodevelopmental risks, including cerebral palsy and intellectual impairment. Postnatal steroid use was a key risk factor for these disabilities.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Public Health
Background:
- Extreme-low-birth-weight (ELBW) infants are at high risk for adverse neurodevelopmental outcomes.
- Early identification and intervention are crucial for improving long-term prognosis.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes of ELBW survivors in Hong Kong.
- To identify risk factors associated with major neurodevelopmental disabilities in this population.
Main Methods:
- A multicentre cohort study involving ELBW infants born in 2001-2002.
- Neurodevelopmental, neurosensory, and functional assessments were conducted through the High Risk Follow-up Program.
- Prospective data collection included demographic characteristics, neonatal diagnoses, treatments, and risk factors for disability.
Main Results:
- Of 49 ELBW infants assessed (mean gestational age 26.2 weeks, mean birth weight 789g), 31% had at least one major disability.
- Cerebral palsy, intellectual impairment, hearing deficit, and visual impairment rates were 12%, 16%, 4%, and 6%, respectively.
- Postnatal steroid use, severe intraventricular hemorrhage, periventricular leukomalacia, and necrotizing enterocolitis were significant risk factors for neurodevelopmental disabilities.
Conclusions:
- ELBW infants are susceptible to major neurodevelopmental disabilities, with rates comparable to international studies.
- No association was found between neurodevelopmental disability and low birth weight itself.
- Further longitudinal research is necessary to understand the long-term neurodevelopmental trajectories of ELBW survivors.
Objective:
To report the neurodevelopmental outcomes of extreme-low-birth-weight survivors.
Design:
Multicentre cohort study.
Setting:
Three regional hospitals in Hong Kong.
Patients:
Surviving extreme-low-birth-weight infants born in 2001 and 2002 underwent neurodevelopmental, neurosensory, and functional assessment under the High Risk Follow-up Program in three Child Assessment Centres.
Main Outcome Measures:
Demographic characteristics, neonatal diagnoses and treatment given, as well as neurodevelopmental outcomes were prospectively collected, and possible maternal and neonatal risk factors for major disability evaluated.
Results:
Of 81 extreme-low-birth-weight infants, 49 had undergone evaluation under the High Risk Follow-up Program. Their mean gestational age was 26.2 (standard deviation, 1.8) weeks and mean birth weight was 789 g (standard deviation, 125 g). Seventeen infants were less than 750 g and 32 were between 751 and 999 g. The rates of cerebral palsy, intellectual impairment, hearing deficit, and visual impairment were 12%, 16%, 4%, and 6%, respectively. Fifteen (31%) infants had at least one major disability. There was no association between neurodevelopmental disability and low birth weight. For neurodevelopmental disabilities, postnatal use of steroids conferred a significant risk (relative risk=7.4; 95% confidence interval, 1.9-29.2). Corresponding figures for other significant risk factors were as follows: severe grades of intraventricular haemorrhage (2.7; 1.2-5.9), presence of periventricular leukomalacia (4.5; 2.1-9.3), patent ductus arteriosus requiring ligation (2.8; 1.3-6.1), severe grades of retinopathy of prematurity (2.4; 1.0-5.6), and severe grades of necrotising enterocolitis (3.2; 1.6-6.3).
Conclusion:
Extreme-low-birth-weight infants are at risk of major neurodevelopmental disability. Our rates of cerebral palsy, intellectual disability, and significant visual and hearing impairment were comparable to those reported in many western studies. Further longitudinal study to assess long-term neurodevelopmental outcomes in this group of children is needed.
