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Published on: November 20, 2015
Early school outcomes for extremely preterm infants with transient neurological abnormalities
Heidi M Harmon1, H Gerry Taylor1, Nori Minich1
1Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.
Insights
Transient neurological abnormalities (TNA) in extremely preterm infants at 9 months predict lower cognitive and academic skills by age 6, even with later normal assessments. This highlights risks for preterm children.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Neurodevelopmental outcomes
Background:
- Extremely preterm infants are at high risk for neurodevelopmental deficits.
- Transient neurological abnormalities (TNA) are common in this population.
- Predictive value of early neurological assessments for long-term outcomes requires further investigation.
Purpose of the Study:
- To determine if transient neurological abnormalities (TNA) identified at 9 months corrected age predict cognitive, behavioral, and motor outcomes at 6 years of age in extremely preterm infants.
- To assess the long-term impact of early neurological status on school-age functioning.
Main Methods:
- A cohort of 124 extremely preterm infants (gestational age 25.5 weeks) were assessed using the Amiel-Tison Neurological Assessment at 9 and 20 months corrected age.
- Infants were classified into groups: TNA (n=17), normal neurological assessment (n=89), or neurologically abnormal assessment (n=18).
- Children underwent comprehensive assessments of cognition, academic achievement, motor ability, and behavior at approximately 6 years of age.
Main Results:
- Children with a history of TNA showed significantly lower adjusted mean scores in spatial relations, visual matching, letter-word identification, and spelling compared to those with normal neurological assessments.
- Higher postnatal steroid exposure was observed in the TNA group (35% vs 9%).
- Cognitive and academic deficits were evident despite normalized neurological assessments by 20 months in the TNA group.
Conclusions:
- Extremely preterm children with a history of transient neurological abnormalities (TNA) are at increased risk for poorer cognitive and academic outcomes in early school years.
- Even with a normalized neurological assessment by 20 months corrected age, a history of TNA indicates a persistent vulnerability.
- These findings underscore the importance of continued monitoring and support for extremely preterm infants, particularly those with early neurological disturbances.
Aim:
To determine if transient neurological abnormalities (TNA) at 9 months corrected age predict cognitive, behavioral, and motor outcomes at 6 years of age in extremely preterm infants.
Method:
A cohort of 124 extremely preterm infants (mean gestational age 25.5wks; 55 males, 69 females), admitted to our unit between 2001 and 2003, were classified based on the Amiel-Tison Neurological Assessment at 9 months and 20 months corrected age as having TNA (n=17), normal neurological assessment (n=89), or neurologically abnormal assessment (n=18). The children were assessed at a mean age of 5 years 11 months (SD 4mo) on cognition, academic achievement, motor ability, and behavior.
Results:
Compared with children with a normal neurological assessment, children with TNA had higher postnatal exposure to steroids (35% vs 9%) and lower adjusted mean scores on spatial relations (84 [standard error {SE} 5] vs 98 [SE 2]), visual matching (79 [SE 5] vs 91 [SE 2]), letter-word identification (97 [SE 4] vs 108 [SE 1]), and spelling (76 [SE 4] vs 96 [SE 2]) (all p<0.05).
Interpretation:
Despite a normalized neurological assessment, extremely preterm children with a history TNA are at higher risk for lower cognitive and academic skills than those with normal neurological findings during their first year of school.
