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Updated: Jun 12, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Two-year neurodevelopmental outcome of preterm born children ≤ 750 g at birth
M J Claas1, H W Bruinse, C Koopman
1Department of Obstetrics and Gynaecology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, the Netherlands. m.j.claas@umcutrecht.nl
Insights
Survival of extremely low birthweight infants increased, but neurodevelopmental outcomes at two years worsened, particularly for small for gestational age infants. This highlights a need for targeted interventions for high-risk neonates.
Area of Science:
- Neonatal intensive care
- Developmental pediatrics
- Perinatal epidemiology
Background:
- Extremely low birthweight (ELBW) infants (<750g) face significant neurodevelopmental challenges.
- Improved survival rates in ELBW infants necessitate understanding long-term outcomes.
- Gestational age and birth weight are critical factors influencing infant development.
Purpose of the Study:
- To assess 2-year neurodevelopmental outcomes (NDO) in ELBW infants.
- To compare NDO between two consecutive 5-year birth cohorts (1996-2000 vs. 2001-2005).
- To evaluate NDO differences between appropriate for gestational age (AGA) and small for gestational age (SGA) infants.
Main Methods:
- Retrospective cohort study of 146 ELBW infants (born 1996-2005) admitted to a neonatal intensive care unit.
- 111 survivors were assessed at 2 years corrected age using developmental scales (Griffiths or Bayley-II).
- NDO was categorized as normal, mildly delayed, or severely delayed based on Z-scores.
Main Results:
- Overall survival increased from 65.8% to 88.1% between the two cohorts (p=0.002).
- Normal NDO at 2 years decreased in the later cohort (66.1% vs. 84.4%, p=0.042).
- SGA infants had significantly lower rates of normal NDO compared to AGA infants (64.3% vs. 86.7%, p=0.012).
Conclusions:
- Increased survival in ELBW infants is associated with a higher incidence of impaired neurodevelopmental outcomes at two years.
- Small for gestational age infants represent a particularly vulnerable group requiring focused developmental monitoring.
- Neonatal care advancements improving survival must be paralleled by strategies to optimize long-term neurodevelopment.
Objectives:
To describe 2-year neurodevelopmental outcome (NDO) in a cohort of extremely low birthweight infants, and compare NDO between two consecutive 5-year periods and between appropriate (AGA, ≥p10) and small for gestational age (SGA,
Design:
Retrospective cohort study.
Setting:
Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Patients:
146 children, born between 1996 and 2005, with a birth weight ≤750 g and a gestational age ≥24 weeks, admitted to the neonatal intensive care unit. 111 children (76%) survived the neonatal period.
Interventions:
At 2 years corrected age, 101 children (cohort I: born in 1996-2000, n=45 and cohort II: born in 2001-2005, n=56) were assessed with either the Griffiths Mental Developmental Scales or the Mental Scale of the Bayley Scales of Infant Development, second edition.
Main Outcome Measures:
NDO, classified as normal (≤-1 Z score ≥0), mildly delayed (>-1 Z score ≤-2) or severely delayed (Z score >-2).
Results:
74.3% of the children had a normal NDO at 2 years corrected age, 20.8% a mildly and 5% a severely delayed outcome. Although survival significantly increased with time (65.8% to 88.1%, p=0.002), significantly fewer children in cohort II (66.1% vs 84.4% in cohort I, p=0.042) as well as fewer SGA children (64.3% vs 86.7% of AGA children, p=0.012) had a normal NDO.
Conclusions:
Increased survival of infants with a birth weight ≤750 g coincided with more children with an impaired NDO at 2 years corrected age. SGA infants are especially at risk of impaired NDO.
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