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Neurodevelopmental outcome after extreme prematurity: a review of the literature
1Section of Child Neurology and Developmental Neuroscience, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas; Section of Developmental Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Insights
Infants born extremely preterm (≤25 weeks gestation) face high mortality and significant neurodevelopmental disabilities. Survivors often experience long-term impairments, highlighting the need for early interventions.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Public Health
Background:
- Advances in neonatal care and reproductive technologies have increased survival rates for extremely preterm infants (born ≤25 weeks' gestation).
- Despite improved survival, there is a concerning rise in morbidity, particularly neurodevelopmental disabilities, among these vulnerable infants.
- Understanding the prevalence and patterns of these adverse outcomes is crucial for clinical care, family guidance, and future research.
Purpose of the Study:
- To review and synthesize the existing literature on neurodevelopmental outcomes in extremely preterm infants.
- To provide an overview of the mortality rates, short-term and long-term disabilities, and survival rates with minimal impairment.
Main Methods:
- A systematic literature search was conducted on PubMed and Ovid Medline for articles published between 1999 and 2013.
- The search focused on full-text English articles reporting neurodevelopmental outcomes in infants born at extreme prematurity (≤25 weeks' gestation).
- A review of identified relevant cohort studies was performed.
Main Results:
- Extreme prematurity (22-25 weeks' gestation) is associated with high mortality (≥50%) and significant rates of severe neurodevelopmental disabilities (17%-59%) in survivors.
- The likelihood of surviving with minimal or no impairment is low (<20% for ≤25 weeks, <5% for 22-23 weeks).
- Long-term adverse outcomes include intellectual disability, cerebral palsy, blindness, and deafness, with milder cognitive and behavioral issues increasingly recognized.
Conclusions:
- Infants born at ≤25 weeks' gestation have a low probability of surviving without significant impairment.
- Approximately half of extremely preterm survivors experience substantial neurodevelopmental disabilities.
- Early intervention programs, family support, and special educational services are vital for improving neurodevelopmental outcomes and future prospects.
Background:
Advances in obstetric and neonatal medical care and assisted reproductive technology have increased the rates of preterm birth, decreased preterm mortality rates, and lowered the limit of viability. However, morbidity in survivors, including neurodevelopmental disabilities, has increased, especially in extremely preterm infants born at ≤25 weeks' gestation. A better understanding of the prevalence and patterns of adverse neurodevelopmental outcomes in extremely preterm infants is important for patient care, counseling of families, and research.
Methods:
The PubMed and Ovid Medline databases were searched for full text articles published between 1999 and 2013 in English that reported neurodevelopmental outcomes after extreme prematurity, and a review of identified relevant cohort studies was performed.
Results:
Extreme prematurity of 22 to 25 weeks' gestation is associated with an overall high mortality of ≥50%. High rates (17% to 59%) of severe neurodevelopmental disabilities occur among survivors on short-term follow-up. The rates of surviving unimpaired or minimally impaired are 6% to 20% for live-born infants at ≤25 weeks' gestation and <5% for infants born at 22 and 23 weeks' gestation. Long-term adverse outcomes after extreme prematurity include intellectual disability (5% to 36%), cerebral palsy (9% to 18%), blindness (0.7% to 9%), and deafness (2% to 4%). Milder degrees of disability involving cognition, behavior, and learning are increasingly recognized among older preterm children, teens, and young adults.
Conclusions:
Infants who are born at ≤25 weeks' gestation, especially those born at 22 and 23 weeks' gestation, have a very low likelihood of surviving little or no impairment. Nearly half of surviving extremely premature infants have significant neurodevelopmental disabilities on short- and long-term follow-up. Instituting early intervention programs, providing family support, and establishing special educational school programs can pay high dividends and lead to brighter futures and, hence, help improve neurodevelopmental outcome of preterm infants.
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