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Relationship between neurodevelopmental status of very preterm infants at one and four years
A L Stewart1, A M Costello, P A Hamilton
1Department of Paediatrics, University College and Middlesex School of Medicine, Rayne Institute, London.
Insights
Neurodevelopmental impairments in very preterm infants can emerge or worsen by age four. Early identification of major impairments at one year is accurate, but cognitive deficits may appear later.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Neonatology
Background:
- Very preterm infants are at high risk for neurodevelopmental impairments.
- Longitudinal assessment is crucial for understanding developmental trajectories.
- Early identification of impairments aids timely intervention.
Purpose of the Study:
- To assess the neurodevelopmental status of very preterm infants at one and four years of age.
- To identify patterns of impairment development and stability over time.
- To evaluate the predictive accuracy of early assessments for later outcomes.
Main Methods:
- Neurodevelopmental status was assessed in 171 very preterm infants at one and four years.
- Classifications included major and minor impairments, neuromotor function, hearing, and cognitive functioning.
- Longitudinal data analysis tracked changes and stability of impairments.
Main Results:
- The prevalence of major impairments increased from 17 at one year to 25 at four years.
- Major impairments at one year had a 94% probability of persisting or developing further by four years.
- Cognitive deficits emerged in a significant proportion of infants between one and four years, accounting for increased impairment rates.
Conclusions:
- Neurodevelopmental assessment at one year accurately identifies major neuromotor and hearing impairments.
- Cognitive impairments can emerge between one and four years in preterm infants.
- Longitudinal monitoring is essential to capture the evolving neurodevelopmental profile of very preterm infants.
Abstract:
The neurodevelopmental status of 171 very preterm infants was assessed at one and four years of age. At one year 17 had major impairments and 14 had minor ones. At four years the numbers had increased to 25 with major and 25 with minor impairments. Infants with no impairments at one year had a 4 per cent probability of a major impairment at four years, whereas infants with a major impairment had a 94 per cent probability. Infants who later proved to have major neuromotor impairments had been accurately identified at one year, as had infants with sensorineural hearing-loss. Infants with minor impairments of tone and reflexes at one year did not develop cerebral movement disorder, but as a group their scores on tests of cognitive functioning were low. An additional group of infants with cognitive impairments was identified who were unimpaired at one year. The emergence of cognitive deficits largely accounted for the increase in impairments between one and four years.