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Updated: May 16, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Follow-up study of 2-year-olds born at very low gestational age in Estonia
Liis Toome1, Heili Varendi, Mairi Männamaa
1Department of Paediatrics, University of Tartu, Tartu, Estonia. liis.toome@lastehaigla.ee
Insights
Very low gestational age (VLGA) infants show higher rates of adverse outcomes, including neurodevelopmental impairment and growth delay, compared to full-term infants. Severe neonatal cerebral lesions are key predictors of these negative outcomes.
Area of Science:
- Neonatal care
- Developmental pediatrics
- Perinatal epidemiology
Background:
- Very low gestational age (VLGA, <32 weeks) infants face significant risks for adverse outcomes.
- Understanding predictors of these outcomes is crucial for targeted interventions.
Purpose of the Study:
- To assess the neurodevelopmental and somatic outcomes of VLGA infants at 2 years of age.
- To identify predictors of adverse outcomes in this vulnerable population.
Main Methods:
- A population-based cohort study of 155 surviving VLGA infants born in Estonia.
- Comparison with a matched full-term (FT) control group.
- Logistic regression analysis to identify risk factors for adverse outcomes.
Main Results:
- 60% of VLGA infants had no impairment; 12% had neurodevelopmental impairment (cerebral palsy, cognitive/language delay, hearing impairment).
- VLGA infants showed significantly lower cognitive, language, and motor scores (Bayley-III) than FT infants.
- Somatic growth delay was prevalent; severe neonatal cerebral lesions predicted adverse outcomes.
Conclusions:
- Adverse conditions were more common in VLGA infants compared to FT controls across all studied domains.
- Reducing neonatal morbidity in preterm infants is a critical healthcare priority.
- Early identification of predictors like neonatal cerebral lesions can guide management.
Aim:
To study very low gestational age (VLGA, <32 weeks) infants at 2 years of age and to identify the predictors of adverse outcomes.
Methods:
A population-based cohort of 155 surviving VLGA infants born in Estonia in 2007 was followed up and compared with a matched full-term (FT) control group. A logistic regression model was used to test associations between risk factors and adverse outcomes.
Results:
No impairment was found in 60% of the VLGA infants. Neurodevelopmental impairment was noted in 12% of VLGA infants, with 8% of the infants affected by cerebral palsy without independent walking, 5% with cognitive delay, 10% with language delay and 1% with hearing impairment. The differences between preterm and FT infants in terms of the mean Cognitive, Language, and Motor Composite Scores assessed using the Bayley-III scales were in excess of 0.5 SD. Somatic growth delay was a significant problem among preterm infants. The existence of severe neonatal cerebral lesions was the most significant predictor of adverse outcomes.
Conclusion:
In all domains studied, adverse conditions were more prevalent among VLGA infants than among the FT control group. Efforts to reduce neonatal morbidity in preterm infants should be a key priority for health care in Estonia.
