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Risk factors for major neurodevelopmental impairments and need for special education resources in extremely premature
M E Msall1, G M Buck, B T Rogers
1Department of Pediatrics, Children's Hospital of Buffalo, NY 14209.
Insights
Extreme prematurity survivors face significant neurodevelopmental risks. Biomedical factors like hydrocephalus increase impairment risk, while sociodemographic factors impact educational needs.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Public Health
Background:
- Infants born extremely prematurely (24-28 weeks gestation) have a high risk of neurodevelopmental impairments.
- Long-term outcomes for this vulnerable population require thorough investigation.
Purpose of the Study:
- To determine the incidence of major neurodevelopmental impairments in survivors of extreme prematurity.
- To identify risk factors associated with these impairments and the need for special educational resources.
Main Methods:
- A cohort of 100 infants born between 24-28 weeks gestation was followed.
- Neurodevelopmental and psychometric assessments were conducted on survivors at a mean of 60 months.
- Univariate analyses identified risk factors for cerebral palsy, mental retardation, and special education needs.
Main Results:
- 25% of infants died; 75% survived. Of survivors, 25% had major impairments (mental retardation, cerebral palsy, blindness).
- Hydrocephalus, intraventricular hemorrhage, low Apgar scores, and bronchopulmonary dysplasia were linked to cerebral palsy.
- Sepsis, low socioeconomic status, and nonwhite race predicted the need for special education.
Conclusions:
- Biomedical factors are primary drivers of major neurodevelopmental impairments in extremely premature infants.
- Sociodemographic factors significantly influence educational risk and outcomes.
- Interventions focusing on both biomedical and developmental-social aspects are crucial for this population.
Abstract:
The purpose of this cohort study was to determine the incidence of and risk factors for major neurodevelopmental impairments among survivors of extreme prematurity. The study cohort comprised 100 infants born between 24 and 28 weeks of gestational age at one tertiary center from 1983 to 1984. Twenty-five infants (25%) died; 75 (75%) survived until follow-up (mean, 60 months). Standardized neurodevelopmental and psychometric assessments were performed in blind fashion on 68 of the 75 surviving children (91% follow-up). Informal assessments (parent, teacher, and physician reports) were obtained instead for seven (9%) children who had relocated outside of the area. Overall, 19 children (25%) had one or more major impairments: mental retardation, 9; cerebral palsy, 4; multiple impairments, 5; and blindness, 1. Despite a high prevalence of impairments, 95% of children (n = 71) were functionally independent [corrected]. Special educational resources were definitely necessary for seven (9%) and possibly needed for 36 (48%) additional children. Univariate analyses revealed four significant risk factors for cerebral palsy: hydrocephalus (relative risk = 12.2), grades III and IV intraventricular hemorrhage (relative risk = 5.8), 5-minute Apgar score lower than 7 (relative risk = 5.7), and bronchopulmonary dysplasia (relative risk = 5.5). Hydrocephalus was the only significant risk factor observed for mental retardation (relative risk = 5.4). Risk factors predicting a need for special education resources included sepsis (relative risk = 24.9), low socioeconomic status (relative risk = 16.3), and nonwhite race (relative risk = 3.0). Thus our data suggest that biomedical factors appear to confer the greatest risk of major impairments; sociodemographic factors appear to have a significant impact on educational risk in extremely premature infants who do not die. Continued follow-up with biomedical and developmental-social interventions appears warranted to decrease the risk of educational underachievement in this population.